Bloodletting and Miraculous Cures (25 page)

(Initial consultation note of Dr. R. Zenkie, FRCPC, dated March 18, 2003—excerpted from chart with permission of Toronto South General Hospital)

ID: Dr. Chen, 31 years old

OCC: Emergency physician

CC: Shortness of breath, fever

Dear Dr. Chen,

Thank you for this consultation. As you know, you developed a fever and some mild shortness of breath on March 17, which was the third day of your quarantine after contact with a probable
SARS
patient, Dr. Fitzgerald. You alerted me and, after we discussed the matter on the phone, you presented to the hospital (travelling appropriately with an N95 mask in a private vehicle) and were admitted directly into a respiratory isolation room. At present, I note that you have only mild shortness of breath not requiring supplementary oxygen. Your X-ray findings demonstrate diffuse infiltrates consistent with an early case of
SARS
.
You are otherwise healthy. Ceftriaxone, azithromycin, acyclovir, ribavirin, and solumedrol have been initiated. Since we agreed that no other physician should be exposed by becoming involved in your care, I will address you in the consultation notes.

Contact tracing is being carried out by the Department of Public Health. Thank you for another interesting consultation, although I regret that you have now come under my care. As per your request I will ensure that your wife,
Dr. Ming, who is currently under quarantine, receives copies of the medical record.

Yours truly, Dr. R. Zenkie, FRCPC

Consultant in Infectious Diseases, Toronto South General Hospital

 

At quarter to midnight, Dr. Chen was admitted to the respiratory isolation room adjacent to Dr. Fitzgerald's. These rooms were fishbowls, walled with glass and humming with the fans that created a negative pressure environment, sucked the air out to be filtered. Each of the rooms had a television and a phone. From inside the room, the occupant could see nurses and doctors passing in the hallway, appearing and disappearing with the casual nerve of those who had not been imprisoned. There were curtains that could be drawn on the inside, but the cardiac and saturation monitors that trailed wires from Chen and Fitzgerald's bodies were always watching them, a peephole even with the curtains drawn. Fitzgerald wrote the extension number of his phone on a piece of paper and held it up to the glass. Chen called him.

“Sorry,” said Fitz. “I gave you this
SARS
thing.”

Chen said, “It's an infection. It's not you.”

“Did you give it to anyone?” Fitzgerald knew that Ming and Chen had married a year ago, that they were now Mr. and Mrs. Chen, although she still used Dr. Ming. “You still single, or what?”

“My wife's in quarantine. Afebrile, though. She's
been on call a lot this week so we haven't seen each other much. Maybe for the best…considering.”

“Right.”

“It's late,” said Chen. He looked up at the curtains.

“Sure. Hey, what's your phone extension? We can catch up.”

Fitzgerald realized that there was a time when he would have simultaneously wanted Ming to have contracted this illness and yet given anything for her to be healthy. Now this was all far away, dull and subject to illumination by the impartial swinging spotlight of infectious illness. He was glad that Chen was here, a familiar face.

 

The next morning, Fitz turned up his oxygen to fifteen litres per minute. He watched TV.
SARS
was now in Canada, Germany, Taiwan, China, Thailand, Hong Kong, Vietnam, and Singapore. The numbers seemed to grow by multiplication instead of addition. The cloud of humidified oxygen that blew into his face left him breathless, and through the glass he saw Chen talking on the phone. He talked for a long time. Hung up. Looked like a man who was adapting to being a fish in a tank. Seven minutes, Fitz thought. The windows of this ward looked over the back of the hospital where there was now a tent, and a line of hospital staff waiting to be screened for entry. As if the hospital was worth lining up for. The nurse who brought lunch (forty-five seconds) was one he had not met before,
Dolores. Her eyes were red. She told Fitz that this was no longer a regular ward, that it was the new
SARS
unit, to which nurses had been assigned by lottery.

 

Earlier that day, Dolores had sat down in the cafeteria for the second
SARS
Strategic Meeting among a masked, garish army of yellow and blue isolation gowns. None of the Toronto South General nurses knew that there would be a lottery. The creation of a dedicated
SARS
unit was explained by the administrator who wore a grey dress and a mask. It would be simple. All of the ward nurses had to be entered in the lottery. If someone didn't want to be in the draw, there was a sheet of paper they could sign, said the administrator. If you signed this paper, you were out of the lottery but you also forfeited recognition of your seniority. Seniority was what nurses built over a career, what entitled them to a better choice of shifts, to the first pick of holidays, to be the last one laid off in a spasm of restructuring, what made a nurse somebody. A masked union rep sat next to the administrator, nothing else for her to say. If you signed the paper, you had to leave the room. You weren't fired, but would possibly be reassigned, depending on what was required after the results of the lottery.

Some who had recently graduated from nursing school got up quickly, signed the paper, and were gone. They didn't have much seniority, and some had small children. One nurse stood and asked if they could
exercise their retirement instead of signing the paper. The union rep looked like she was about to answer, but then turned to the administrator instead. The two of them murmured mask to mask. The union rep stood and said, “This situation does not annul any previously determined benefits.”

The union rep and the administrator conferred, and produced another sheet of paper for nurses who wanted to exercise their retirement. Another small number stood one by one to sign. They looked at their colleagues, but because of the masks could not tell whether the glances were farewell smiles, gazes of consolation, or eyes met as a warning. Most of the nurses who signed the second sheet of paper had been at the hospital since before many of the younger nurses were born. One had actually delivered one of the junior nurses because the doctor couldn't get there in time.

Dolores kept her seat. Her divorce settlement had only just been completed. There were the three kids, the second mortgage, and the twelve years of seniority which were too many to throw away. In one box were everyone's names. In another box were yellow and red tags. One by one, the union rep drew a name, the administrator drew a tag, stapled the name to the tag. The red tags meant the
SARS
unit. Dolores's name was drawn, and then out came a red tag.

Afterwards, those with yellow tags tried to suppress the relief and laughter of a near miss, embarrassed at their good fortune while standing amid those who held
red tags. Those who had been selected for the
SARS
unit only met the eyes of others who held the same colour tag. Some cried openly, or left the room to do so. One woman with a yellow tag offered it to her friend who had a red one, and who was just back from her honeymoon, but the trade was refused. Grief and trauma counsellors were available in the next room, said the union rep over the murmur. No one offered Dolores a trade. Management left the room once the lottery was completed.

 

March 18, 2003 (from the files of the World Health Organization)

Data indicate that the overwhelming majority of cases occur in health care workers, their family members, and others having close face-to-face contact with patients…

 

After lunch, and the noontime vitals and IV replacements (two minutes, fifteen seconds), Fitzgerald called Chen. Through the glass, they could see each other's monitors. Chen had been on the phone all morning with Ming and his family members. Fitzgerald had been flipping between news channels. They compared and discussed their vital signs, which were all abnormal. Chen said, “You remember Sri's funeral?”

“Sure. Everyone was there—even though it was the day before the royal college exams.”

“Ming and I were talking about it. One day he felt a little itchy, thought his eyes looked a bit yellow. Did you
know he had me order the labs? Dead within a year. It was astounding.”

“Pancreatic cancer,” said Fitz. “Nasty.”

“Did you know that Sri once made eggs Benedict for a patient?”

“Eggs Benedict?”

“You know, poached eggs with that lemony sauce.”

“Must have been a good cook.”

“We were juniors, and Sri had this patient, Mr. Olaf. Cannonball lesions all over his lungs, brain mets, all his family dead in Sweden. He had written a will on lined paper, that his clothes and books should go to his landlady. Olaf had no visitors, and I remember Sri saying how sad it was that he was all alone. He was always smiling, though, reading his Swedish Bible, and the chaplain came every day. So one day we're rounding, and Mr. Olaf has this look…as if he's figured out some amazing thing. You can tell he's just bursting to tell us what he's thought of, and right in the middle of our rounds he picks up and says, ‘Doctors, excuse me, sirs, but may it be possible to kindly arrange for me to partake in some eggs Benedict? Perhaps with bacon?'

“The staff guy was Arnold. He writes an order in the chart:
EGGS BENEDICT
. Later that day, we're in a family conference and Sri gets paged. He goes off, comes back, says that the nurses are upset at the order, saying it's an inappropriate order to put in a medical chart, yada yada yada, and who do the doctors think the nurses are, anyhow, personal chefs? Later, Sri calls the kitchen
himself and asks them if they make eggs Benedict. He finds a cook who says he can make it, but that he doesn't think he's allowed to deviate from the regular menu. Sri calls again. He finds some other guy who says he'd be happy to make anything, but he doesn't know the Benedict variety of eggs. Meanwhile, the nurse has decided to make it into an
issue.
You know how it is, once an
issue
is created. The nurse asks the dietitian to consult, because of course Olaf has high blood pressure and high cholesterol. The dietitian doesn't know what this is all about, but she writes dietary recommendations in the chart—a low-salt, low-fat diet. Arnold sees this, so he just writes:
LOW-SALT, LOW-FAT DIET AS PER DIETITIAN
. Next day, Mr. Olaf is eating his low-salt, low-fat porridge and tea with no sugar or milk for breakfast while we're rounding. Doesn't say a word until the end of the rounds, when he shyly says, ‘Excuse me, doctors, sirs, I apologize humbly for my lavish request of the eggs Benedict. But would it be possible to restore the regular food?' You should have seen him, poking that hard porridge.

“Arnold writes DAT on the chart. Later, Sri is paged while we're in a seminar. He goes off, comes back, says another nurse is peeved about these contradictory orders. First, eggs Benedict, then low-salt low-fat, then DAT. Sri cancels all the previous orders and writes DAT—
DIET AS TOLERATED
again. The next morning, I see he's got some little containers with him. I ask him what they are, and he says it's his lunch. But later, when
we're rounding, there's Mr. Olaf with a great big spread of eggs Benedict and bacon and home fries, digging in like he's found a preview of heaven. All the time while we're rounding, he's smiling and nodding at Sri, grinning like a madman.”

“Sri was a good guy,” said Fitzgerald. “I barely recognized him at the viewing—that open casket thing they do.”

“Lost a lot of weight. I hadn't seen him since he got sick. So fast, eight months. At least a few times I saw Sri with his little stack of containers, then Olaf died a week later. One day, I think he had waffles.”

Fitzgerald said, “Isn't it amazing how weight loss changes the face? Especially when the body is supine. Changes the way everything sits.”

“Gravity shapes everything,” said Chen. “First, I couldn't believe that he was gone. Then, I couldn't believe that I couldn't believe it. After all, how many dead people have we seen? How many have we watched die?”

Fitz coughed, and it took him like a shaking fist, forced him to put down the phone until he was able to stop and wipe the perspiration from his face. He picked it up again and said, “You want to order something?”

“What, fancy eggs?”

“I'd like a seared tuna steak with wasabi mashed potatoes and vintage port.”

“Pan-fried crabs,” said Chen, “with lots of scallions and garlic.”

“Scallops. Big, fat Nova Scotia scallops browned in butter with asparagus, wild rice, and a bottle of Gewurztraminer.”

 

March 19, 2003 (from the files of the World Health Organization)

Brother-in-law of Guangdong doctor dies in a Hong Kong hospital.

 

Both of them watched TV all day. Switched between the stations. Mostly stayed on the news, the
SARS
clips over and over again: mask shortages, enforced quarantines, panic spreading like flight trajectories between cities. Later that night, after dinner, Fitz called Chen. Through the glass, Chen saw Fitzgerald hold the phone, a spasm of coughing, his hands shaking like the tailpipe on a cold car. Chen said, “This shakiness business of yours. I know you have a few from time to time.”

“What?”

“Booze. Are you withdrawing?”

“I guess.”

“Get some diazepam.”

“No way. Zenkie's writing it up. ‘Tremor: A Novel Aspect of the
SARS
Syndrome.' You want to take away his paper?”

“What if you seize?”

“Fuck it. I'd rather be famous. The Zenkie-Fitzgerald Tremor—an atypical manifestation of
SARS
. I'm going to be a co-author.”