Bloodletting and Miraculous Cures (26 page)

“You better tell Zenkie, and get some diazepam.”

“Right, I'll tell him and in forty seconds the whole hospital will know.”

Chen was about to say that it didn't matter, because after the night when Fitz had arrived for a shift with the sweet smell on his breath, his speech slurred, and was asked to leave and stop seeing patients, it didn't make a difference whether people knew he was withdrawing. But Chen didn't say it, because maybe Fitz didn't know how much people had talked in that indelible way. Fitz had resigned from the hospital the next day, signed on with the flight company. Chen said, “Instead, you'll seize and die.”

“Who said death was so bad?”

“Did someone say that?”

Fitz had a coughing fit, and then, “When did we forget what it meant to die?”

“Probably at night.”

“Yeah, it would have been late.”

“One night…I was very tired,” said Chen. “There was this hysterical family. You know the kind—they stare at you when you sit down to write a chart, they grab you to tell you that they read something on the Internet. Their mother was going to die. It had taken me a long time to convince them that there was no other way. Every half-hour I would get paged, and the nurse would say, ‘They want to speak to you again.' Don't you hate that? When it's not even a particular problem, but they just want to speak to you? Finally I
told them that Mom wasn't going to die tonight, that they should save their strength for the next day.”

“And as soon as they left, she died.”

“Of course.”

“Always the way.”

“It was three o'clock. I had been running back and forth from emerg and it had finally quietened down. I told the nurse that she didn't need to check on the woman until the morning. We both knew.”

“You didn't call the family.”

“I just couldn't. I was exhausted. I called when I woke up, and filled out the death certificate as if she had just passed away. By the time they got to the hospital and started their wailing and carrying on, I was out the door.”

“That's not so bad. They needed the sleep. Imagine if they came in at three o'clock? The whole floor would be awake, and then you'd be fucked.”

“Later, I felt like maybe I should have called. But I just felt that way kind of theoretically. I didn't really care.”

“You took care of the patient, right?” said Fitz. “The rest is your own business. What's your temp today?”

“Thirty-nine.” Neither of them wanted to take too much antipyretic. Both of their livers were already reeling from the cocktail of drugs.

“I'm forty,” said Fitz. Even through the glass, Chen could see the sweat-glaze on Fitz's skin, and a slight collapse of facial features. “One morning, I was post-call. I went to that park in Kensington, you know the corner
stand where they make fresh chocolate croissants and serve latte out the window? Yeah. Those mornings when the weather is so fresh, and you're kind of stoned but awake, on those days sometimes I wouldn't sleep, I would take the ferry to Centre Island. Wander around. Watch the moms and kids on the toy train.”

Fitzgerald didn't mention the rum he put in his post-call latte. Not a lot, just enough to soothe. He said, “That was my plan. I had my nice big latte, my warm croissant, and the sun was just up. This woman is walking across the park. She goes up to this picnic table where this guy looks like he's asleep, slumped over. I don't know why she does this, but she tries to wake him up. He doesn't wake up. She shakes him. He's just lying there, and I'm drinking my latte thinking either he's dead, or he's a heroin addict. I decide that he's probably not dead because he's too floppy, unless he just died, so he's probably a junkie. People gather around while this woman slaps the guy and shouts at him. I laugh because she tries to move him and obviously she's never moved anyone before—his head just flops back and goes
bonk
when she drags him onto the ground. On the dirt, mind you, it's nice and soft. I zip up my jacket, because otherwise you can see my scrub top. This woman freaks out. She starts to scream, ‘Call 911, call 911,' and all these people look at her like maybe this is performance art? Finally, someone takes out a cellphone and calls.

“I imagined what would happen if I went over there. He would be fine, just a junkie on junk, but I'd
be standing there all doctor-like and therefore unable to escape. Or, maybe he would be dead. Then I'd start CPR, although if he was dead all that time it wouldn't matter, but if I was playing Mr. Doctor then I'd have to do something to make it look good, I'd have to do mouth-to-mouth and he would vomit in my mouth, and then whether he was okay or dead, by the time the ambulance guys came, either some homeless guy would have stolen my croissant and latte or it would be cold.”

“But then…” prompted Chen, and he saw from Fitzgerald's slump that the funny ending and heroic anecdote that these types of stories usually concluded with would not come.

Fitzgerald said, “So the woman starts CPR. She hasn't even checked for a pulse, and in fact I think I can see him breathing, so she would totally fail an ACLS course. Anyhow, she's doing it like squirrel CPR.
Boop boop boop
on his chest. Must have seen it on TV. She's got the two-hand thing going, elbows locked, but she's barely touching the guy. I figured that if he was actually alive, her CPR wasn't going to hurt him much, and if he was dead, none of this would matter. Then the ambulance came. I had to watch, because I was convinced that he was breathing, just to see whether I was right. Sure, they tubed him. I heard him sucking on the tube, and they weren't pumping him. See? I knew he had vital signs.”

“Sometimes you can tell from a distance,” said Chen.

“Sure,” said Fitzgerald. A coughing fit. He wondered if he would have told the story if the ambulance
crew had started CPR, if in fact the guy had died. No. He knew that he would have just kept it to himself. As it was, Chen was the first person he had told.

“Did you go to Centre Island?”

“Yeah, but that whole incident soured my day.”

“It's cute out on the Island, isn't it? All the rides, and the kids in the swan boats, driving those little cars.”

“I like it out there,” said Fitzgerald. Fitzgerald thought of a ferry trip to the Island with Ming before she met Chen, and was surprised that he could remember this without bitterness, without needing to know whether Chen knew that Ming and Fitzgerald had once spent a sunny afternoon on Centre Island. He felt good, that it was mostly a pleasant memory of a woman whom he now hardly knew, and of himself as a person remembered. A slight pang, of course, but after an unusual length of sobriety he was able to see that this was mostly a pang for his present aloneness, and that there was no truth to representing it otherwise. “Listen, if I go down the drain, and I think I will, I don't want to be tubed or resuscitated or anything. It's not worth it.”

 

(Portion of progress note of Dr. R. Zenkie, FRCPC, dated March 20, 2003—excerpted from chart with permission of Toronto South General Hospital)

…and as his clinical situation continues to worsen, Dr. Fitzgerald has indicated his wish to not be resuscitated should he deteriorate to the point that he requires
intubation. He has told me that should this occur, he would not want to expose other staff to the
SARS
infection by performing such a high-risk procedure, since he judges that in this instance his chances of survival would be slim. I am inclined to wonder whether Dr. Fitzgerald may be suffering from an acute situational depression, and therefore may not be competent to make this decision. At this point, I am refraining from writing a DNR order, because of my doubts about the state of Dr. Fitzgerald's mental health.

Yours truly, Dr. R. Zenkie, FRCPC

Consultant in Infectious Diseases, Toronto South General Hospital

(NB: Also on March 20, Dr. Zenkie ordered diazepam 10 mg by mouth every one hour as needed by Dr. Fitzgerald to treat persistent tremor. No other explanation of this order is noted in the chart.)

 

Dolores explained to the daycare director that she, herself, had no fever, no respiratory symptoms, that she was screened daily at the hospital and checked her own temperature at home at least twice. Certainly, her children were perfectly healthy. She had had no unprotected contact, she said, and could not be considered to be a suspect or probable case. The daycare director said that it wasn't that she had any problem with the situation. No, it was just that the parents of the other children felt…uncomfortable. Dolores asked why those parents didn't just keep their kids at home, then. Well,
that would be unfair to them, said the daycare woman, and it wasn't that she was forbidding Dolores's kids from coming, it was just that maybe they should…think about things a bit. Already, Dolores's children had told her that the other kids wouldn't play with them, had been told not to by their parents.

Dolores found a babysitter who could provide both daycare for the little ones and after-school care for Dolores's older daughter. Dolores told her that she worked in the sanitation industry, and explained to the kids that they shouldn't tell anyone that Mommy was a nurse. Why not? her daughter asked. Because people are silly, Dolores said. For how long do we keep it secret? her son asked. Dolores said that she wasn't sure how long it would be. It might be a while.

 

On March 21, Chen saw that Fitzgerald sucked on his oxygen with all the heaving muscles in his chest, that he ate ice from a cup next to him. Chen called Fitzgerald and asked how he was doing. Great, replied Fitzgerald.

“Hey, you remember that guy, that old German internist, the one who did his residency in India? He would talk that crazy German-accented Hindi to all the Indian patients. They loved him. What was his name, Glug-something? Gland?”

“Gerstein.”

“Were you there when he convinced that woman she needed a spinal tap?”

“Remind me.”

“The one-in-a-hundred thing…”

“Oh, of course,” said Fitzgerald. Both he and Chen began to laugh. Dr. Gerstein had been their attending when they were consulted about a patient with a headache. Her story raised suspicions of a subarachnoid hemorrhage, and the CT scan was negative. Dr. Gerstein explained to the woman, in the German-accented Hindi-influenced English he had learned in Bombay, that even though the CT scan was negative, there was a one percent chance that it could be wrong, and a lumbar puncture was necessary in order to be certain.

“One percent,” she said. “I'm scared of needles.”

“A subarachnoid could kill you,” Dr. Gerstein said.

“But one percent. That's one in a hundred. You would put a needle into my spinal cord for one in a hundred?”

“Actually, into the spinal canal. We would avoid the cord.”

“Maybe I'll take my chances,” the woman said. “One percent isn't bad.”

At that, Dr. Gerstein made for the door, leaving Dr. Chen and Dr. Fitzgerald standing at the woman's bedside. They did not know whether to follow him. They knew that this woman needed the lumbar puncture, and that sometimes Gerstein would abandon difficult tasks, such as convincing a patient of the wisdom of medical guidance, to his house staff. At the door, Gerstein turned, widened his stance. He made his hands into a pistol and raised them, pointed the two-fingered barrel straight at the woman.

He said, “I just picked up one of a hundred Mauser pistols that were sitting here outside the room. One of them is loaded, and I don't know which one. Regardless, the gun is trained on your forehead. I'll leave it up to you. Would you like me to pull the trigger?”

The woman's eyes were fixed on the muzzle of Gerstein's fingertips.

“The safety is off, shall I pull the trigger?”

Chen and Fitzgerald's chests thumped in sudden fear. Gerstein stood absolutely still, stared down his gun barrel until he smiled—not ironically, not exactly kindly, but mostly with sadness at the reality of decision making.

Fifteen minutes later, clear cerebrospinal fluid trickled into the needle embedded between that woman's fourth and fifth lumbar vertebrae.

“Like a gunslinger in a western,” said Chen. “High noon at the spinal tap corral.” Both he and Fitz were laughing.

Fitz said, “You think we'll die?”

“Maybe.” The laughter continued.

“Me, more likely. I'm on a hundred percent.” He knew that Chen was only on four litres of oxygen per minute. “It's not so bad,” said Fitzgerald. “If we die with only a few hundred others, we'll be
SARS
martyrs. If thousands get it but they find a cure and our deaths help, then it's worthwhile. If this thing just goes wild and the whole world dies by the millions, then we'll miss the worst of it. See? Can't lose.” By the time he had finished saying this, they were both sober.

“When I try to remember, I can't recall when I learned about death,” said Chen. “How it's ordinary, but like a sudden hole in the world. I learned it, then I forgot, or maybe I just began to ignore it. Ming and I were talking about kids. Maybe next year.”

“I'm a fuckup anyhow. Better for me to croak. You stick around.” The mention of Ming made Fitzgerald angry and sick with himself, his drinking, his aloneness. He told himself resolutely that losing her hadn't influenced the shape of his life, but when he drank he did not believe this. When the bottle sank him below the comfort zone, Ming was one of the if-only-it-had-been-another-way things that became vivid. Fitzgerald decided from Chen's comfortable manner with him that Ming had never mentioned Fitzgerald, and only once at a departmental party had they all been in the same room. He and Chen had never been very close, but when you do months of “team medicine” together, you end up acting like buddies out of necessity. Now, being in respiratory isolation together, calling each other on the phone, it was like those times.