Bloodletting and Miraculous Cures

by Vincent Lam

  “Jeez, that stings.”

  “We need the IV to give you the heart attack medicine,” says Jill, as she connects the tubing to flush the line.

  “Are you people listening?” asks Mr. Santorini. “I can’t be having a heart attack.”

  “You got it?” I say to Jill. I swirl the vial of powder and water to dissolve it. The box says to swirl, not shake.

  The line doesn’t run. She says, “It’s blown. This is pathetic. Am I alone?” She says louder, “What does it take to get some help in here?”

  I stand again where Mr. Santorini can’t see me. I wave my hands, bare my teeth, and mouth stop it! at Jill, who laughs.

  Lenny appears. He says, “I can’t find any IV sets—the cart is empty.”

  “Good Lord. Get Wanda. Page Wanda.”

  Lenny says, “Just tell me where. Is there a stock?”

  “Lenny, just page Wanda to come do it.”

  Mr. Santorini suddenly cringes at his chest, puts a fist to it. “Oh, wow. Yesterday I fell. Maybe I pulled a muscle or something. Give me something for the pain and I’ll go home.”

  On the twelve lead monitor, I see his ST segments rising, his heart being starved of oxygen, the muscle becoming liquid and dark like an apple with a soft, rotting core.

  “Sir,” I say. “Do you pay your taxes?” I fix my gaze on him, to take his attention away from Jill’s new jab at his arm.

  “Of course. I have a slick accountant, but sure I—”

  I come close to his face. I look straight and unblinking into his eyes. “Do you know why you pay your taxes?” The drug in the vial is now dissolved. I draw up the clear liquid, a little more than the exact dose.

  “I have to, otherwise—”

  “You pay your taxes so that I can be here at midnight after having spent many years in school, and so that I can tell you without a shadow of a doubt that your heart is in the process of infarcting and we need to use your tax dollars to do something about it.” I say it nicely—like I would sell a used Hyundai if I were a car salesman.

  “Oh,” he says.

  Wanda rushes in. On each side, the nurses tourniquet and flick his arms, probe for veins.

  “We have the state of the art, the best, the latest. This is the Cadillac, Mr. Santorini. This is recombinant thrombolytic. It was a breakthrough twenty years ago, it’s been refined since then, and it’s superb. Minuscule risk of stroke. Hardly ever happens. I want the best for you, because you are an upstanding citizen, a taxpayer, and a rollerblader. You owe it to yourself, and I owe it to you.” I flick the bubbles to the top of the syringe, squirt out the tiny pocket of air, and plunge the barrel to the exact dose. “You want to blade again?”

  “Whaddya—”

  “Yes or no. You want to rollerblade again, Mr. Santorini?”

  “Of course I do.”

  “Then you need this treatment. If you want to blade, you need this drug.”

  I watch his arms, Jill on one side and Wanda on the other. Almost simultaneously, I see the red burst in each barrel of the IV sets.

  “Got it?” I ask. They have. On each side, we have a line. Both run well.

  Mr. Santorini suddenly arches his back, holds his chest. “Jeez, it’s like a moose sitting on my chest. Oh my God. Okay, doc, whatever you think.”

  “Twenty-three fifty-four, pushing the lytic,” I say, plunging the syringe into the happily running tube in the right arm.

  1:30—Twelve patients waiting, three hours behind

  From midnight to three is running time. Tired and thirsty. The patients pace the waiting room, or shake their stretchers. This part of the night is for fighting. It has escaped the civility of day and evening, but has not yet slipped into the dreaming, drugged morning before light. These hours are the child who kicks and screams himself to sleep. The cop asks the nurse, How much longer? The patient says to the clerk, Where is the doctor? The nurse says to me, Come and see this guy first. He’s driving me crazy. The patients develop additional medical problems while they wait. They construct opinions about how they should be treated. Opinions! Later it will be easier, because they will be like sedated animals and they won’t care, but now it is all arguing and pushing. I sit when I’m in the patients’ rooms, to promote the illusion of time. While I write in the charts, while I jot the orders, I stand because it forces me to keep moving.

  2:20—Room 17. Mrs. Amin: thirty-nine years old with hiccups

  I cure Mrs. Amin’s hiccups by bringing her a large plastic cup of ice water and a thin white straw. I have her plug her ears tightly, pushing both her right and left tragus (that little triangle of springy flesh that arcs backwards over the ear canal).

  I cheerlead, “Go, drink, go, go, don’t stop!” She follows my instructions and drinks the entire glass of water through the straw without pause, without releasing the pressure over her ears. The hiccups stop. I love it.

  “Miraculous,” she says, smiling. She does not hiccup.

  I love doing this because hiccups are of no significance, because this entertaining clinical intervention works, and I have no idea why it works. There is delicious freedom in doing something I do not understand, which cures a condition of no importance.

  After this long, drawn-out clinical encounter (six minutes), Mrs. Amin says, “While I’m here, could you look at this rash?”

  “How long have you had it?”

  “Four years.”

  “We focus on emergencies.”

  “I’ve been waiting three hours. You can’t look at my rash?” Already, she has thrust her arms out, pulled up the sleeves to show me her angry, peeling elbows. It looks like psoriasis.

  I say, “Looks like psoriasis.”

  “I’ve got three creams, none work.”

  “Great. See your family doctor.”

  “I would like to see a dermatologist.”

  “Wonderful. Your family doctor knows a good one.”

  “I’ve been here four hours. You could call a dermatologist.”

  “We don’t have dermatologists.”

  “Pardon?”

  “This hospital has none. Even if we did, they wouldn’t come at two-thirty in the morning. Dermatologists like to sleep. That’s why I’m here, because I don’t like to sleep so I have nothing better to do than look at your rash.”

  “Excuse me?”

  “That’s right, I am so happy to look at your rash that I can’t contain myself. Nothing else to do! I don’t need to see the other fifteen patients who are waiting with their heart attacks and broken bones. Thank goodness for your rash, because I would otherwise be bored silly.” I am afraid that she will begin to hiccup again, but there is no sign of it.

  “Doctor, isn’t this an emergency ward?”

  I can’t think of anything to say except, “Yes.”

  Mrs. Amin scrunches her eyes at me, says, “Isn’t this an emergency ward?”

  “Your psoriasis is not an emergency. It’s not related to the hiccups, for which you came here and which I have cured although they were also not an emergency, so consider yourself very fortunate.”

  Mrs. Amin stares at me.

  I say, “I will now leave, shortly after which you must walk away from this hospital. Thank you.”

  “What’s your name, doctor?”

  “Dr. Chen.”

  “Can you spell that?”

  “C-H-E-N. Let me write it down for you. I’m going to write my physician registration number, too, and the name of the head of the department, and his phone number. Can I help you in any other way?”

  “We’ll be in touch.”

  “I look forward to it. Move along, then.”

  I feel satisfied, a wormy little righteousness. I hold the curtain, “Go on. Out.” She goes. I sit down to write the chart, and I document the encounter completely, such that there can be no question about the appropriateness of my words and actions. I describe our discussion of the hiccups, my differential diagnosis of hiccups, my successful hiccup treatment, and the follow-up plan f
or further hiccup care. I write that the patient mentioned that she had chronic psoriasis, that I examined the rash, that I informed her of our lack of a dermatology service, and that I encouraged her to follow up through her family doctor who is providing ongoing care. It is the most complete and verbose note I have written all night, and it is almost legible. There are fifteen lines of somewhat readable text to describe the nine minutes between 2:13 and 2:22.

  2:45—Three patients waiting, less than twenty minutes behind

  4:55—I feel strangely alert lying on this stretcher

  At night, the minor area of the department is closed. I am in a darkened room, curtain pulled, socks dry-sticky on my feet. I have inclined the head of the stretcher upward because there are no pillows in the department. My shoes are at the side of the stretcher. On the rolling steel tray, next to suture kits and vomit basins, is my jumble of accessories: pager, mask, Palm Pilot, pen, wallet, energy bar, extra pen, vial of stool test reagent, extra mask. With all of these things removed, I am suddenly weightless.

  I am alert, I am aware, I think that the wavy blue curtain resembles water. Hallway light glows through it as if I were in a cave behind a waterfall. I feel so vivid and wired that I don’t notice the approach to sleep.

  5:25—Suddenly awake

  “Dr. Chen.”

  A face, a curtain pulled aside, I can’t see who.

  “Unnhh?”

  “Dr. Chen!”

  “Yeah. I’m awake!” A panic, a heart-pounding proclamation, “I’m awake.” Did I say that twice? I’m not sure what I said and what I dreamt.

  “Brady at thirty. Pressure of fifty on nothing, ETA three minutes.”

  The voice: I think it’s a nurse. Where’re my glasses? Did I fall asleep? Of course I did—that strange instant sleep I can’t remember happening, where one second I had the awareness of waterfalls and curtains, then now this fuzzy face-voice. Shit, where are my glasses? Brady at thirty. Probably new heart block. Stumble into shoes. My feet night-swollen, I stuff my wallet, my Palm Pilot into pockets. The nausea. Where the heck—Oh, screw the glasses. No, I need the glasses, I can’t run this thing blind.

  Sick feeling.

  I stand at the sink. Heave, dry heave, spit, gargle a little water. Feels a bit better. Stunned, echoing awakeness. Brady. Jeez, couldn’t wait a few hours? I feel around the tray, then the cart next to it. I pad around until I feel the wire of my glasses. Aha! Once on my face, they make the light glaring, hard. Now that I can see, I realize my headache.

  I check my watch. I slept half an hour. Fifteen more minutes would have been great. There’s such a difference between half an hour of sleep and forty-five minutes, forty-five minutes and an hour, an hour and two. Two hours is bliss, a revelation of humanity, a soft dawning morning. An hour is enough—enough that the night has been broken and I can stand on it, casually shuffle my feet over its back. Forty-five minutes is like a deep breath, like a good sigh, a fresh drink, but it is just a moment’s reprieve and sad in its ending. Half an hour is laying down and being smacked awake, then the sick feeling.

  Dry heave. Hands on the sink. The motion of vomiting feels good, as if expelling the nausea although nothing comes out. Spit. Rinse.

  Shuffle down the hall, face greasy-cold.

  “Dr. Chen!” It is Magdalena, coming down the hall. It was also her before, I realize. Her voice is more urgent, and I seem to hear better now that I have my glasses.

  “Oh, yes, I’m awake. I’m fine, I’m awake.”

  “The brady-hypotensive just pulled up.”

  “Excellent. That’s just great,” I say with thick-tongued deliberateness. “Thank you, Magdalena.”

  Shuffle faster.

  5:28—Moonwalking, making war

  Stretcher rolls in, trundles across the floor. The medics, the nurses, me: we move, talk, act as a crowd—bouncing off each other. We mill and grab, become a mob. Beep beep, always the monitors, beep beep. The blanket is a stunning orange. I say, “Move him into the bed.” The sagging form of man. I say, “Accucheck, please, bolus a litre.” It feels like those films of men on the moon who jump and take a forever leap, who launch a golf ball that disappears against black sky while the narrator says, All skies would be black without our oxygenated atmosphere. Beep beep beep. The guy has a shit blood pressure. His skin is the white on blue web-lace lines of death. “Atropine point six going in,” I say as I inject. This is also my nightmare of war; the enemy invisible, shots in the dark, everyone rushing, confused, but in one tiny panicked place all is such calm because the end is near or the end is far, but there is no way to know. Somewhere there is a truce. Nurses and medics shout to grab this, hand me that, push it here, get the blue box. I say to the tall medic with the goatee, “Tell me the story again. Once more.” He speaks in a loud voice, pedantic, eyes on his notes—a recitation over the ritual. He recounts how they were called, what they found, what they gave him already. I’m pushing drugs again. I say, “Atropine point six. Get me a rhythm strip, Clarice. Clarice! Put that down, it can wait, get me a rhythm strip.” I believe there is music on the moon. In the documentaries, there’s always music. Bach, or Mozart. Once, I saw Neil Armstrong with a soundtrack of Erik Satie’s piano Gymnopedies—the astronauts suspended on delicate melody. Like that, floating, I call the orders, touch the patient, feel his belly, put my stethoscope on his side. I shine light in his eyes, they squeeze reflexively: dreamy, unreal. I say, “Atropine point eight.” Each small move is accentuated. I say something, call out an order, and someone begins to do it, like my own golf ball hurtling away. But maybe it is not heard, so it is not done. Maybe it is done but by the time it is done, I change the order. The patient has changed already. The soldiers run, stab at shadows, hurl themselves at machine sounds. Beep beep. I trace the rhythm strip. Aha, a Mobitz II. “Let’s put on the Zohl,” I say. Fighting in space, I think they too would use a weapon called a Zohl.

  The hydraulic hiss of the ambulance doors. Another crew, another stretcher. I say, “Hi guys, join the party.” The charge nurse angry—why didn’t you call? The medic defensive—we called, this is the bradycardia. The charge nurse to the first medic crew—what’s going on here, did you call? The goateed medic shrugs—sure, we called. Two patients, same story. I say, “Maybe they both called, did we think it was one crew?” The charge nurse waves the second stretcher into the next bay. The battle extends, now a voice overhead asks for more combatants, for float nurses. I give the orders for each bay. I think I am being clear but maybe I am not. I say, “No, not that one, give it to the other guy.” I pull back the curtain between the two stretchers, to see them both. I am floating, moonwalking. I am somewhere between the two monitors, beepbeepbeepbeep. The rhythms, the drugs, the orders: this is all back there somewhere in my medically sublimated subconscious, like bicycle riding. Floating, everything so slow. Then the second guy in failure, fluid filling the lungs, spilling over. Bad pressure, heart failure. I think, Bad. I say, “Dopamine, please.” The first guy paced—it’s not picking up well. “Put it up to sixty,” I say. The second guy in vee-fib. Over him now with the paddles: Shock. “All clear!” Shock. “All clear!” Shock, the body jumps.

  Start CPR on the second guy. Gravity is diluted, and it is so slow…it all happens drifting sideways. I say, “Push Amio three hundred.” It’s as if it’s compressed into one single moment of rushing, shouting, wrappers on the floor, blood on the arm, foot poking out from under the sheet. I am over him again with the paddles, another zap of electric current. Again. “All clear!” Shock again. No good. “All clear! Shock.”

  On and on, five minutes, ten minutes. The second guy getting cold.

  The second guy dead.

  “What’s happening, doc?” says Zack.

  I say, “He died.”

  “What do you need?”

  “Get me a transvenous pacer.” I turn away from the second patient.

  The first guy’s external pacer is not picking up reliably. I puncture a hole in his groin, thrust the large-
bore metal needle home, thread the wires up into the heart. That’s better. He’s picking up well now.

  I call cardiology to take him upstairs.

  6:10—Sitting behind the desk in the resuscitation room

  The five bays fill my field of vision. I have the feeling of morning although there is no natural light here. A sunrise on the dark side.

  I pick up the phone and call the desk clerk. “Mo,” I don’t know her full name, only know her as Mo, “it’s Dr. Chen.”

  “Hi.”

  “You know that pizza place on Gerrard? They also deliver chicken wings, right?”

  “It’s six in the morning, doc.”

  “Maybe shawarma, or something?” I am hungry, craving meat.

  “Just Tim’s. You want a soup? But they don’t deliver.”

  “Soup. Oh, nah. Forget it.”

  “Doc, wait a second—”

  “Yeah.”

  “What’s the name of the guy in bay four? I gotta do the papers.”

  “What guy?”

  “Bay four.”

  “It’s empty. There’s no one there.” I’m looking at it. Empty. A cleaner sweeps up a mess.

  “But wasn’t there—”

  I wonder if Mo wants the name of the cleaner. Then I see what she means.

  “Oh, you’re right, there was someone there.”

  “What’s his name?”

  Mo is asking about the man who was there until five minutes ago, until he was wheeled into the pink room to wait for the coroner. I make that leap of understanding.

  “Oh, the dead guy?”

  “Right. What’s his name?”

  “Umm…I don’t know, let me see. I think the papers are here. Didn’t the ambulance guys leave the call sheet? Must have. Hmm…I was writing in the chart. Now, where the heck. Well, that’s a good question, Mo. Maybe if I—”

  “Never mind, doc, I’ll come look for it.”

  “Sure. Sorry.”

  Hang up.

  Things like this confuse me. Lost papers, cleaners.

  Until 6:55