Bloodletting and Miraculous Cures (27 page)

“Not what I meant,” said Chen.

“That's the way it is. I told Zenkie to write a
DO NOT RESUSCITATE
on my chart.”

“You're being crazy.”

“Of course not. It's just common sense. Look, everyone who gets tubed dies. While they're getting tubed, the resuscitation team catches it. Then some of the
people who tubed the guy who died get so sick that they need to be tubed. And so on. They should cut us off from everyone, like a leper colony.”

“This is early, a new disease. There're intubated people who haven't died yet.”

“Come on. You think we ever beat outbreaks? They run their course, they burn themselves out. It's just a question of how many people get burnt up in the process. Spanish flu, forty million dead, more than the First World War.”

“Something like that.”

 

(Transcript of Dr. R. Zenkie, FRCPC, dictated March 22, 2003—never transcribed because of deviations from standard dictation format—recovered from electronic transcription system with permission of Toronto South General Hospital)

ID: I am Dr. Ronald Zenkie, infectious disease consultant and avid nature photographer

CC: Fever, shortness of breath, heightened awareness of societal paranoia

(nervous laugh)

To whom it may concern,

(pause for coughing fit)

I am taking the unusual step of dictating my own admission note. Today, I woke with chills and myalgias. My temperature, measured orally, was 39. Over the day, I have become progressively more short of breath, and have developed a cough.

I think I have a cold, just a regular cold, but these days you never know.

(pause for coughing fit)

Erase last sentence, please.

It is probable that I am suffering from a relatively innocent upper respiratory tract infection. However, it must be noted that I may be perceived as being at high risk for contraction of
SARS
, and thus it is appropriate that I mandate my own admission to the
SARS
unit in the interests of public safety.

How about that, huh? Down with the ship.

(prolonged bout of laughter and coughing)

Shit.

Erase last sentence and expletive, please.

I have discussed my clinical responsibilities, which will be assumed by Dr. Waterman, who will act as the interim attending staff on the
SARS
unit.

Yours truly, Dr. R. Zenkie, FRCPC

Consultant in Infectious Diseases, Toronto South General Hospital

 

(Addendum to
SARS
Bulletin 14, issued on March 25.)

To All Staff,

We are sad to inform you that after a short illness, Dr. R. Zenkie has succumbed to
SARS
. Our condolences to his family, and thanks for his twenty-six years of service to the Toronto South General Hospital. Staff members who have been in contact with Dr. R. Zenkie have been contacted personally, but are reminded that
they are now on work quarantine. All such staff should leave their homes only to go to work, using a private vehicle such as a personal car or a taxi. Masks must be worn between home and hospital at all times. At home, all such staff are reminded to sleep in separate rooms from their spouses, to sit at a minimum distance of 1 metre (3 feet) from family members during meals, and preferably to eat in a separate room. There should be no physical contact with children or other family members. All staff on work quarantine should shower at work, or shower in a separate area of the home from their family members, because of the possible aerosolization of
SARS
infectious material within showers. Body temperature should be measured a minimum of twice per day, and any oral temperature greater than
38
must be reported immediately. Dr. Zenkie is survived by his wife, Amita, who is admitted in our
SARS
unit and asks that donations be made to
UNICEF
in lieu of flowers or gifts. The memorial service for Dr. Zenkie is indefinitely postponed, and we would remind staff that all gatherings of hospital staff outside of the hospital are forbidden.

Yours truly,

SARS
Action Management Team

 

The morning rush. The line behind the hospital trailed out of the tent and into the parking lot. There was an April drizzle but people did not huddle close to each other's umbrellas. Those with umbrellas stood their ground, and those with bare heads stood at a more than
socially polite distance from each other, and gradually became wet. Arriving for the day shift. Dolores eyed the boxes of masks to see whether the blue ones, which were the least constrictive, were available. There were no blue masks. Only the white, itchy ones.

She saw that some people produced blue masks from their pockets and bags. They had hoarded the comfortable masks, she realized. Dolores had not done so, but decided that the next time she saw a box of the blue masks she would slip five or six of them into her purse. If it rained tomorrow, she thought, then she should bring an umbrella. Or maybe not. If she brought one, someone might try to stand too close to her.

Ahead, people filed past the dispensers of antiseptic handwash, squirted the bottles, and rubbed their hands and forearms. They gathered up their daily bundle of isolation gowns and scrubs, stood one by one in front of the masked screeners so that body temperatures could be measured with the ear probe, and to answer the same screening questions asked the day before. Dolores saw that one man had his temperature taken a second time. He shook his head. Then a third. He protested. A fourth. A look of resignation. A screener pushed a second mask at him and led him out the side flap of the tent, to somewhere else. Dolores saw that there were security people at each corner of the tent. They did not move, but they, like Dolores, watched this happen. What was the difference between being led away and being taken away? None, she decided, when a security
guard stood at each corner of the tent, when everyone had instructions to follow.

Dolores began to feel warm. The line murmured, looked down, continued to move forward and present their ears for temperature measurement. Yes, she definitely felt warm. It was 7:20, and she should already be getting a signover report from the night shift, but she definitely felt a heat. Then she coughed. A cough. One, and was there another? It did not seem so, but her body temperature was intense, her heart beating. She was not yet inside the tent. She was still in the portion of the line that stood in the drizzle, that was still connected to the outside world of wind and water, a world that did not exist inside the hospital. Suddenly, Dolores wondered who would pick up the kids from the sitter and bring them home if she couldn't? Their father now lived three time zones away, her closest family was two time zones distant. What would happen if she got to the front of the line and had a temperature? They couldn't live with the babysitter. They would end up in a foster home until she got better. 7:23. Or what if she didn't get better?

No one noticed, Dolores thought, as she ducked out of the line, as she made for her car. She did not look back to see whether anyone followed her with their eyes. Now, she had missed report. All the way home she felt hotter and hotter, more and more inflamed. A fit of coughing at a red light, but maybe she had just swallowed wrong? Told herself to drive carefully. She slammed the car door,
rushed into the house in her wet shoes, made for the bathroom, and only once the digital thermometer was in her mouth did she think,
But if I have a temperature, then I don't want to be in contact with my kids.

The metal wand under her tongue, she remembered with a panic the report she had read that speculated that
SARS
infectious material might remain contagious even for days outside of the body. What was she doing? What was she thinking? She was in the process of contaminating her children's home. Whereas all this time she had been thinking only of the problem of picking up her children from the babysitter and bringing them home, now she wanted more than anything to keep them away from this place—this place that she was now transforming into a cesspool of disease. She felt a tickle, a scratchiness, needed to cough, needed to hold the thermometer under her tongue.

Beeeep
.

36.6. Afebrile. No fever.

Dolores sat on the toilet, drank a glass of water. The cough seemed to be gone. She took her temperature again, and wrote it down on a scrap of paper from her purse. And again, shoes still dripping onto the bathroom mat. Wrote down the second temperature. Did it five times, all of the temperatures perfectly normal. The cough was gone. She averaged the five temperatures. The average was 36.5. Normal.

The phone rang. It was the nurse in charge of the
SARS
unit. Dolores had been seen ducking out of the line.

“No, no,” she said, “not a fever. Just dizziness. I get this sometimes, these horrible episodes of dizziness. Usually lasts a few days.

“No, not a fever.

“No, don't send public health, no, it would be a waste.

“Definitely not.

“I checked five times.

“Yes.

“Yes.

“I know exactly what it is, so book me off the schedule for at least three days.”

 

(Transcript of an evening news clip of April 3, 2003—reproduced with permission of CBC Television)

Today, an unusual occurrence at the Toronto South General Hospital
SARS
Unit: This morning, alarms indicated a breach in the
SARS
respiratory isolation rooms. What is known as a Code Orange alert was activated, placing the facility in Disaster Response mode. After several minutes, the Code Orange was deactivated. Hospital officials assure us that there was no external breach, and that no unprotected hospital staff were placed at risk. Initially, hospital officials refused to explain the incident, but with speculation heightening throughout the day, a statement has been released. It seems that a
SARS
patient, Dr. Fitzgerald, became unable to breathe and collapsed within an isolation room. As the
SARS
medical team donned their protective gear in order to enter the room
and administer treatment to Dr. Fitzgerald, the
SARS
patient in the room adjacent to his, Dr. Chen, broke through the glass partition between their rooms with an intravenous pole, in order to initiate emergency treatment for Dr. Fitzgerald. The Code Orange alarm was activated by this glass being broken but, once again, hospital officials insist that no unprotected staff were exposed. Dr. Fitzgerald is reported to be in critical condition. Dr. Chen is reported to have cut his arm on broken glass, but is otherwise stable. The hospital declined to comment on their assessment of Dr. Chen's actions, which they described as being “outside standard protocol.” Dr. Chen was reached briefly by phone, and stated, “In a critical situation, it takes too long to put on the
SARS
gear, and people die in the delay, but I've already got
SARS
, so I don't need the protection.”

Extreme measures at urgent times.

Meanwhile, on the world front, the number of cases has exceeded two thousand. Chinese authorities have announced three hundred and sixty-one new
SARS
cases and nine new deaths. In Hong Kong, there is strong evidence that the disease has spread beyond its initial focus within hospitals, with secondary and tertiary cases almost certainly occurring in the community at large.

 

BEFORE LIGHT

21:00—Eighth-floor apartment balcony, south of Queen and Spadina

The sun has left the city. The day collapses into a violet glow—this new purple sky which is the warm birth of night. I look down into the bright windows of houses, at two shadows of boys under a street light, and over the convulsive writhing of a tree's body in the wind. I resent night, the long awakening darkness that will be flickered by red, yellow, and green at inter sections, slashed open by arcing headlights, this void gasping for
breath, and punctured by the sudden smash of fist into shouting mouth. I see an ambulance hurtle straight up Spadina Avenue, like a bullet shot into darkness.

 

21:25—Bedroom of apartment

I'm in bed. I tell myself not to look, not to check the time. Not knowing makes me anxious, so I open my eyes again, glimpse the glowing orange numbers: 21:26. I flip from my right side to my left side.
Breathe slowly,
I think. I've been lying here for seventeen minutes: nine minutes on my left, then eight on my right. I feel sad and cheated. I resent my overnight shift in the emergency department, which starts at 23:30. I can never sleep before this late shift, and I always feel desperately certain that if only I could nap, if only I could drift off for a few minutes, it would be much better. I turn onto my right side. The door's edges are rectangles of light. I swing my anxious legs out of bed. I sit. I stand and open the door. Ming is reading, and the living room lights shine brightly.

“Hi,” I say.

“What's wrong?”

“Can't sleep.”

“Try to rest. Resting is good.”

“I hate my job, Ming. I despise it. I have to get
out
of this. I can't do this forever.” I stand in the doorway in my T-shirt and underwear.

Ming doesn't look up. “You hate everything before your night shift. In general, you sort of like your job.”

“Right now, I hate it.” I am aware of the whiteness of my naked legs.

“Fine. Hate it. Feel better?”

“A little.”

She looks up. “You should lie down.”

“Can you come and snuggle?”

“Sure.”

I turn on the air filter for its white hiss. Ming takes off her pants and we lie down. I tell myself to pretend that we're going to bed for the night, that we will be safe until morning. If I could just believe this. Then, with my wife's warm back pressed against my belly, I would sleep. It is urgent that I sleep. I am panicked that I should sleep. The fact that I have to work through the night makes it absolutely crucial that my consciousness fade, that drool begin to fall from the corner of my mouth onto the pillow, that I dream in that liquid way which permits all possibilities.
Sleep, dream,
I think. But this imperative makes me more and more aware that I am not asleep, which makes me force my breathing to become long and drawn out, and then I feel breathless.

In medical school, they once brought a relaxation specialist to our class. She guided a hundred and seventy-seven students, all sitting in the tall and echo-filled lecture hall, through an exercise. We visualized looseness spreading from our toes, to our ankles, to our knees, to our bellies, as tension flowed out of our skin. Some people put their heads on their desks, pens fell from their hands, and they snored. I couldn't get past
my ankles. My toes felt too big to relax. My feet ached. I couldn't make my ankles go limp. I asked myself whether the stronger minds were those who were able to allow the relaxation to take them over, to submit to the slackness of their bodies, or those like myself whose knees and necks continued to fidget and fight. Then I became irritated with myself—
why did it matter who had the stronger mind?

Ming coughs, and shifts. She is lying still for my benefit, but it's not quite the same because typically she falls asleep first. That's how it works. Usually, I become aware of her breathing passing into the involuntary wind of a sleeping body, and this is a trigger for me. This is the thing that must happen before I can let go, before I begin to forget my waking self. Ming coughs a second time.

She says, “I forgot. I have to make a phone call.”

“Can you snuggle a bit longer?”

“It'll be too late to call.” She touches my thigh. “Sorry, you want me to come back after I'm done?”

“It's okay,” I say. I turn so that our curved backs touch each other, and she climbs over me to get out of bed.

“Relax,” she says. “You need it.”

 

22:50—Kitchen

“Have you had enough?” asks Ming.

I have just eaten two big bowls of the leftover stir-fried shrimp on white rice from dinner. I ate them with
a gluttonous determination that I feed myself, that I need it, that at least my night should be fuelled.

“I guess,” I say. Already, I feel the beginning of nausea. My night shifts are underlined by a persistent, hanging, sick feeling.

The bottom cup of a pot of tea sits before me. The tea bags steeped while I drank three successively stronger cups, each with two heaping spoons of sugar.

 

23:20—Lakeshore Boulevard

My shift starts in ten minutes. I'm the second car at the light, stopped right before the Gardiner on-ramp. The first car is a gleaming, bright-white F150 crew cab.
Who drives a pickup truck in the city? Small man, big car. Custom chrome bumper. Loser.

The light's green, buddy. Fuck, get a move on!

The light's green, after all.

Braaaaaaaap.

I thumb the horn long and excessively as I pull out, floor it in second, and blow past the F150. He's talking on the phone, giving me the finger, stomping on the gas now, and trying to cut me off as I duck in front of him in the final metres before the ramp and gun it onto the Gardiner eastbound.

Sucker,
I think. I feel justified in driving this way. I sometimes see people driving recklessly and I wonder whether they really have such a worthwhile place to be. What makes them feel so important? Don't they realize how terrible car accidents happen? But right now, just at
this moment, I have somewhere important to go. I am a linchpin of the city's emergency safety net. I am a night-shift martyr, and if Mr. F150 doesn't notice the green light, he should be dusted off with a vigorous horning.

Coming off the ramp, I'm in third. I zing the tach past five thousand before shifting up, gunning the engine of my silver Benz. I have a mild sense that I should be embarrassed, that I'm a doctor driving a cliché. The F150 is trying to keep up.
No way, man.
I once thought I would defy stereotype, that I would always ride transit. At some point I realized that Mercedes are such nice cars.
It's about the quality,
I tell myself and anyone who sees the car.
And you would be surprised how little I paid for it. It's an excellent used-car value.
It is a shiny CLK 430. Sporty. I can't deny that. I should be embarrassed, but really I'm not. You see, just below the silver paint is a layer of feigned sheepishness, which masks a sense of justification, because really I feel like this car is my due.
Shouldn't I have a kick-ass car? Don't I deserve it?

I hit one-thirty in fourth, pass a taxi on the right, shift up, move back into the left lane. Mr. Pickup Truck is trying to follow. His heavy chrome lurches to the side as he changes lanes.
Laughable!
I want the cops to stop us. They will pull us over and I will show them my Dr. Chen badge. We will recognize each other; they bring people in to me all night long. I will shrug and say, You know how it is, officers. Hospital—the emergency department. They need me. The cop will wave me on,
saying, Night, doctor, and I will zoom away. They will bust the pickup truck instead. I see the custom bumper flash in my side mirror. I pull ahead and cut him off.

I've never been pulled over before.
The pickup truck now darts three lanes to the right, passes a panel van, and surges forward. I tap the accelerator, amazed at how quietly this car does one-sixty.
Do they take you to jail for speeding?
Now, I slow down. I'm suddenly concerned that I may not have the man-to-man, doctor-to-cop macho charisma required to get off a speeding ticket. I slow to just a little over the posted limit, see the F150 approach from behind, pass too close, and sweep in front of me.

Go on, little man. I'm above this sort of thing.
He pulls away.

 

23:35—Toronto South General, emergency loading entrance

Six ambulances, two coppers. The ambulances are angle parked outside, backed into the spaces. The police cars have their noses forward and engines running. It is festive, frenetic, a late-night party. Inside, the fluorescent lights cry out, scream brightly, and the waiting room bubbles with faces. The full daytime lighting gives an out-of-earthly-time feeling, like in a convenience store before dawn. Eyes and hands and shouting at this masquerade ball. Stretchers in the hallway with ambulance crews. Five, I count. Sixth must be in the resuscitation bay.

The charge nurse says, “Twenty-two in the waiting room, six hours behind. Got your runners on, Dr. Chen?”

A man in a purple windbreaker asks, “Are you a doctor? You the doctor?”

“They keep telling me that,” I reply.

 

23:40—Room 8. Mrs. Withrow: eighty-two years old with dizziness

“Hello, Mrs. Withrow, I'm Dr. Chen.”

“Thank you so much.”

“Pleased to meet you. Don't thank me yet.” I pull up a chair. “I understand you've been dizzy.” I was taught that sitting creates the perception of time. I cross my legs and maintain good posture.

“Extremely, terribly dizzy.”

“How long has that been?”

“Oh, a while.”

“A while.” I nod. “How long is a while?”

“It's been bad for
quite
a while. Also, my foot is sore.”

“Quite a while.” I nod again. “All right. Would you say that a while is like a day, or a week, or like a month, or for instance a year? Give me a rough idea.”

Mrs. Withrow ponders this, she gazes up, looks at me with confidence and says, “Let's just say a while.” She presses her lips with finality. “What is your diagnosis, doctor?”

“Let me ask you this, Mrs. Withrow: When did you start thinking of coming to hospital?”

“I've been thinking about the hospital for a
long
time. But just recently I decided to call an ambulance.”

“How long ago is recently?”

“What do you mean by that?”

“Recently,” I say. “When you say ‘recently,' do you mean just this afternoon, or today, or a few days, or a week?”

“I didn't catch the question, doctor. I'm sorry. My hearing aid's at home. Could you speak up?”

I drop my voice into a theatrical baritone. “Mrs. Withrow. Are you dizzy right now?”

“You don't have to shout. I'm not deaf, just hard of hearing.”

I stop. Open my mouth. Close it. “Right now, are you dizzy?”

“Well, no, not at all. I feel better already. Thank you.”

“That's wonderful,” I say in my deepest, operatic boom. “I'm so pleased to hear that you feel better.”

The overhead speakers: “
Doctor to resusc now. Doctor to resusc now.
”

I stand up. “Excuse me.”

 

23:46—Resuscitation bay 1. Mr. Santorini: forty-eight years old with chest pain

He breathes hard, looks scared.

Jill hands me an electrocardiogram. I read the twelve punctuated, jagged lines on the grid paper in the way that my ancient predecessors peered into tea leaves, or
gazed at bones thrown in the sand. The electrocardiogram tells fortunes, is a sudden lightning-strike omen.

I say, “Mr. Santorini, I have some bad news and some good news.”

“What's the good news?” he gasps. He is sweating, melting into the stretcher.

“I'll tell you the bad news first.”