Bloodletting and Miraculous Cures

by Vincent Lam

  I rush through the department. I run from room to room, write on charts, wake up patients, send them home—tell them persuasively that all their tests have proven to be normal. In a frenzy of thread and needle drivers, I sew up two men who slashed each other with broken bottles of cheap shiraz. They cry and hug each other. The security guard has confiscated the bottles. I refer patients to specialists. I make phone calls. I wake surgeons and internists. I cast a broken ankle. The debris of night is falling into the hospital. I fix the broken fist of a drunk engineering student who does not know how to punch.

  Dr. Pielou, the internist, comes to me with a chart in his hand.

  He has just woken up, and he’s ready to fight. He says, “Dr. Chen, you are referring Mr. Stanley with cellulitis.”

  “I am.”

  “This is cellulitis.”

  “That’s what I wrote on the chart: recurrent infections. Both legs.”

  “Why don’t you put the patient on antibiotics and send him home, Dr. Chen?”

  “You’ll understand when you see the patient.”

  “No, I won’t. I refuse to see him. This is unacceptable. Can’t you handle a cellulitis?”

  “Dr. Pielou. Go see the patient and you will understand why you have to admit him.”

  Dr. Pielou sits down on a rolling chair, crosses his right leg in a delicate way over the left. There is only one chair. He says, “I would like you to explain to me why you are referring this patient with cellulitis before I go and see any such patient, Dr. Chen. I don’t want my time wasted.”

  “Within two seconds, when you walk in the room you will understand. Stop wasting both of our time.”

  “This is a poor consult, Dr. Chen.” He tut-tuts, and shakes his head, which causes his second chin to wiggle from side to side.

  “You want to know why I am referring Mr. Stanley?”

  “Yes.”

  “Shall I tell you?”

  “Enlighten me, Dr. Chen.”

  “The patient is fat, Dr. Pielou.”

  He uncrosses his legs, pulls his white coat tightly over his belly and says, “Many people have weight issues.”

  “No, not just fat,” I say. “Mr. Stanley is morbidly obese.”

  “What exactly is your point, Dr. Chen?”

  “No. No. Actually, the truth is that this patient makes the notion of morbidly obese seem skinny. I would prefer not to express these thoughts out loud, but since you insist, let me describe the patient to you.” I leer over Dr. Pielou, coming very close to the chair and looking down at him as I wave my hands in illustration. I speak too loudly. The nurses stare. I say, “Mr. Stanley’s arms hang over the edges of the stretcher. Not the elbows. With the elbows inside the stretcher, the flesh of his arms wraps and hangs over the railings of the stretcher. Have you noticed how most legs are longer than they are wide? This patient is amazing. You will be fascinated, because the width of the legs is similar to the length of each segment. It’s incredible. The legs, instead of being tubular, are more like two globular structures, with feet emerging from the ends. Therefore, Mr. Stanley cannot see his legs to determine whether the infection is getting better or worse. He cannot put his legs up, because they will fall on him and knock him unconscious. He cannot walk. He has a specially reinforced, motorized wheelchair. If I give him oral antibiotics, the tablets will become lost in his elephantine digestive tract. If I send him home, he will come back as a huge septic mass of blubber. That is why you, Dr. Pielou, must perform the heroic task of admitting the patient to hospital and saving him from himself.”

  I look down at Dr. Pielou, who cranes his neck in order to maintain our fixed, hard eye contact. I tower over him, lean forward and hope that he will tilt backwards so far that the chair will fall over. I am not tall enough to achieve this, so I turn and walk away.

  The rolling chair scuttles across the floor as Dr. Pielou loses balance and tumbles to the ground with a soft smacking sound. I turn, and he is pulling himself up. He says, “Dr. Chen, control yourself.”

  Still walking away, I say, “Thank you for seeing the patient, Dr. Pielou.”

  7:00—The morning doc comes. I’m happy to see her

  “How was it?” she asks.

  “The usual.”

  7:15—Southbound on the Don Valley Parkway

  Windows down, sunroof open, the rush of morning air is a tornado in the car. Despite this, I’m sleepy. The music pounds loudly—U2’s Passengers: Original Soundtracks 1. I need the thumping, driving rhythm to disrupt my sleepiness. I have a cold bottle of water from the hospital fridge. I sip. I make myself sip again, even though I’m not thirsty. The bottle sweats and I roll it on my neck.

  The traffic is not stop and go, but all the lanes are full. It is rush hour cruising with sudden spasms of acceleration and deceleration.

  My eyes are about to close. A grey Saab cuts me off. Beeeeeep. I honk.

  I slap myself on the right cheek.

  Shout out loud, sing to the music, “Boopity boop!” rocking my head. There’re no words in this section, so I’m just shouting, “Boppity bop!”

  My eyes pull tight, shut.

  On the left cheek, I slap myself hard.

  Those muscles above the eye are so weak. The eyelids are determined to snap shut like springs, like traps. Slam on the brakes, thrown forward. Jeez. Almost, too close. The line of brake lights is suddenly alive in front of this angry snake halted. I’ve stopped a foot from the grey Saab.

  “Daaa daaa daaa,” I shout. Slap myself.

  The woman in the Malibu on my right looks at me, both of us sitting here in our cars. Did she see me slap myself? Oh well, it’s no one’s business. I slap myself again. She looks ahead, rolls her window up.

  “BAPPITY BOOPITY ARRRRRRRR!” I yell for the stimulant effect.

  I’ve tried to figure out the risks. What’s more dangerous? Is it the mornings when the drive is slow, and I have more time to fall asleep? Or, is it the mornings when the drive is fast and I have less time to fall asleep, but the consequences of unconsciousness would be more dire? I can’t decide. Driving slowly, I wish for the fear of driving fast while sleepy, because sometimes this fear wakes me up.

  I call out letters, spell words like a drill sergeant, like drill bits to bore holes in my sleepiness. “C-A-R-C-R-AS-H-F-E-N-D-E-R-B-E-N-D-E-R-T-O-W-T-R-U-C-K”

  Slap the left cheek.

  The curved ramp onto the elevated Gardiner, and then…

  Just that moment, it comes so quickly, dark rest—sweet.

  The whole car shakes, vibrates, I jerk my head up, guide the car off the shoulder, off the rumble strips. I see the woman in the Malibu is behind me now, keeping her distance.

  “BOPPITY BOO!” I scream, turn the air conditioning on high, the music loud. I pinch my thigh hard, rub my forehead with my knuckles. Another slap.

  7:35—Parking garage. My spot, my car in one piece

  I’ll just lie here for a minute. I’ll just put the seat down, so the neighbours won’t see me.

  8:05—Parking garage. My spot, my car in one piece

  A cracking sound.

  I say, “Unnnnnh.”

  A faraway voice.

  My eyes slit open and I see it is the building caretaker, rapping on the car window. I say, “Morning, Mitchell.”

  “Morning, sir. I was knocking for a while, getting worried, about to call the ambulance.”

  Jeez. I better get up. That’s the last thing I need. An ambulance.

  I get out.

  “You all right, sir?” he asks in his thick-tongued speech.

  “Just fine.”

  “Big night on the town, then?” he winks.

  “You know it.”

  8:10—Our bed. Ming is gone. Her ward rounds start early. The sheets are rumpled but not warm

  Lying there.

  For a moment, I feel so awake. I feel a beautiful alertness, as if the sorrow and calm and joy and exploding furious vengeance of the world have all settled into me and shown themselves to be
the same. Yes, all of an identical essence, different reflections of one basic feeling, one notion, in the way that water is at once an iceberg, the surf, a cloud. Why would I ever sleep?

  Gone.

  Out.

  12:01—Lying in bed. Undecided whether to sleep more

  Mostly, I feel that if only I do not speak, if only I refrain from uttering a single phrase, then everything will be all right. If I talk, it may allow things to spill from me. It could set in motion a vertiginous unbalance, a confusion leading to madness, or a hunger that may cause me to eat until I burst and die. If only I do not speak, I will be fine. I may go see a matinee. Movies are mostly mime, and will not lead to a dangerous escape of words.

  I listen to the street.

  Bells ring. So familiar, at noon.

  The church bells are the sky, are the ether of blue and breeze, and they vibrate from a distance so that the notes intermingle and warble with the hiss of air conditioners. All of this sizzles over the popping rumble of streetcars. The light through the blinds falls diagonally in fat stripes on the floor, and is warm on the carpet whose stains are highlighted and made attractive, important.

  GLOSSARY OF TERMS

  These explanations are provided for the purpose of clarifying the narrative in this work of fiction. While they are believed to be accurate, this is not a medical dictionary. The glossary is not intended to explain medical conditions in any therapeutic way, and does not replace an explanation of any of these terms by a medical professional if they are relevant to your personal health.

  8–0 tube—refers to the size of an endotracheal tube. This is a typical size for an adult male. See endotracheal tube.

  Abdomen—the part of the body cavity below the chest.

  Accucheck—bedside test to determine a patient’s blood sugar level.

  ACLS—advanced cardiac life support. These are standardized protocols for treating cardiac arrest and arrhythmia.

  Acyclovir—an antiviral medication.

  Amiodarone—anti-arrhythmic medication. See arrhythmia.

  Amnesia—loss of memory resulting from injury, disease, drugs, or psychological disturbance.

  Amniotic fluid—fluid contained within the amniotic cavity, the amniotic cavity being the space that contains the embryo and is enclosed by a membrane, the amnion.

  Ampoule—sealed glass or plastic capsule containing one dose of a drug as a sterile solution for injection.

  Antidote—drug that counteracts the effect of a poison, or the overdose of another drug.

  Arrhythmia—deviation from the normal rhythm of the heart.

  Arytenoids—two pyramid-shaped cartilages that lie at the back of the larynx next to the upper edges of the cricoid cartilage. See cricoid cartilage; larynx.

  Atrial electricity—refers to the electrical impulse normally generated in the atria that regulates the normal rhythm of the heart.

  Atropine—drug that inhibits the action of certain regulatory nerves and can be therapeutic in some instances of bradycardia.

  Bicarb—refers to bicarbonate, a medication used in cardiac resuscitation to treat one of the metabolic disturbances (acidosis) that may accompany a near-death physiological state.

  Bigeminy—condition in which alternate ectopic beats of the heart are transmitted. Normally, the heart beats at the rhythm dictated by one centre in the atrium. In bigeminy, the “ectopic” beats are triggered by an abnormal centre of rhythm.

  Blown pupil—refers to a non-reactive, enlarged pupil, and is usually an ominous sign of structural disturbances within the skull. Normally, pupils react to light by becoming smaller, but a blown pupil does not. This may be a sign that a patient is “coning.” See coning; pupil.

  Bolus—rapid administration of fluid or medication.

  Brady—refers to bradycardia, an abnormally slow rhythm of the heart.

  Bronchogram—an X-ray appearance indicating the presence of fluid in the lungs.

  Bypass—refers to cardiac bypass, a surgical procedure in which blocked coronary arteries are circumvented, or “bypassed” by the grafting of vessels that provide blood circulation to the heart.

  Caesarean section—surgical operation for delivering a baby through the abdominal wall.

  Cannula—hollow tube designed for insertion into a body cavity.

  Catheter—flexible tube for insertion into a narrow cavity or blood vessel so that fluid may be introduced or removed.

  Ceftriaxone—an antibiotic.

  Cellulitis—infection of soft tissue.

  Central line—intravenous access to the veins of the body that are not normally close to the skin’s surface, such as the jugular, subclavian, and femoral veins.

  Cerebrospinal fluid—clear watery fluid that surrounds the brain and spinal cord.

  Cervix—necklike part of the uterus that projects into the vagina and is capable of wide dilation during childbirth.

  Coags—refers to coagulation profile, which is a laboratory measure of the clotting time of blood.

  Code blue—refers to cardiac arrest, a situation in which a patient has ceased to breathe and circulate blood spontaneously.

  Code orange—refers to a disaster situation.

  Collateral circulation—alternative route provided for blood by secondary vessels when a primary vessel becomes blocked.

  Compression—within a cardiac arrest, this refers to the act of compressing the chest wall, so as to produce movement of blood through the heart.

  Conduction—transmission of electrical impulses.

  Coning—refers to the displacement of the brain’s structures by an increase in pressure within the skull. This frequently leads to permanent damage of brain tissue, and often to death.

  Conjunctiva—mucous membrane that covers the front of the eye and lines the inside of the eyelids.

  Contact tracing—the practice of locating individuals who may have come in contact with a patient known or suspected of having an infectious illness.

  CPR—refers to cardiac-pulmonary resuscitation, emergency manoeuvres employed to maintain the circulation of oxygen and blood within a body that has ceased to do so itself.

  Crackles—sound heard in the lungs through a stethoscope, signifying the presence of fluid in the lungs.

  Crash cart—refers to a trolley stocked with the equipment and drugs necessary to initially manage a cardiac arrest. (Author’s note: Typically, one of the wheels is jammed, and the particular sizes of equipment needed are missing.)

  Cricoid cartilage—cartilage, shaped like a signet ring, that forms part of the anterior and lateral and most of the posterior wall of the larynx.

  Cricoid pressure—pressure applied to the cricoid cartilage, in order to occlude the esophagus or to reposition the airway for better visualization during airway management. (Author’s note: Although this term is frequently used, it is somewhat of a misnomer in the context of airway repositioning, which, more correctly stated, involves pressure on the thyroid cartilage, found adjacent to the cricoid cartilage.)

  CT—refers to computed tomography, a diagnostic tool that uses an X-ray scanner to record “slices” of the body and then integrates these data to give a cross-sectional image.

  Diazepam—tranquilizer with muscle relaxant and anticonvulsant properties.

  DIC—disseminated intravascular coagulation, a process in which the body’s clotting mechanisms act inappropriately, often resulting in life-threatening failure of multiple vital organs.

  Dopamine—drug used to increase the strength of contraction of the heart.

  Dop-tone—refers to a portable fetal Doppler monitor, which allows rapid assessment of fetal heart rate.

  Endotracheal tube—a semi-rigid tube that is positioned within the trachea to provide oxygen to a patient and prevent stomach contents and other material from entering the lungs.

  Epi—refers to epinephrine, a medication that acts as a cardiac stimulant.

  Esophagus—structure that moves food from the mouth to the stomach.

&nbs
p; ETA—refers to estimated time of arrival.

  FAA—refers to Federal Aviation Authority.

  False cords—refers to arytenoid cartilage. See arytenoids.

  FiO2—fraction of inspired oxygen, a measure of the amount of oxygen in the gas a patient is breathing.

  Flashback—the appearance of blood in the hub of an intravenous catheter as the catheter is positioned. See catheter.

  Float nurse—nurse who is not assigned to a specific area, but who is available to help where the workload is highest.

  Focal deficits—specific neurological findings that imply an area of discrete dysfunction within the nervous system.

  FRCPC—refers to Fellowship of the Royal College of Physicians of Canada.

  Heart block—condition in which conduction of electrical impulses generated by the normal pacemaker of the heart (in the atrium) is impaired, so that the rate and action of the heart’s pumping is impaired.

  Heart failure—condition in which the pumping action of the heart is inadequate, resulting in back pressure of blood and fluid filling the lungs and liver.

  Hemorrhage—bleeding.

  Hemorrhagic stroke—stroke in which the cause is bleeding into the brain tissue. See stroke.

  Hepatitis (B, C)—two strains of illness that affect the liver and are transmissible by contact with bodily fluids.

  Hilum—a hollow on the surface of an organ, such as the heart, where structures such as blood vessels and nerve fibres enter or leave it.

  HIV (1, 2)—refers to two strains of human immunodeficiency virus, an illness transmissible by contact with bodily fluids.

  Hypotensive—abnormally low blood pressure.

  Internist—medical doctor specialized in internal medicine.

  Intracranial pressure—pressure within the skull.

  Krebs cycle—cycle of enzyme-mediation reactions that occurs in the cells of all animals. This is a crucial final step in the conversion of food into energy. (Author’s note: Many an hour have been spent by many a student pondering the intricacies of this aggravatingly complex process. Certain chemical reactions in this cycle frequently appear in dreams.)