Bloodletting and Miraculous Cures (30 page)

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.

ETA
—refers to estimated time of arrival.

FAA
—refers to Federal Aviation Authority.

False cords
—refers to arytenoid cartilage. See
arytenoids.

FiO
₂
—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.)

Laerdal bag
—bag used to push air into the lungs, either via a tightly sealing face mask or an endotracheal tube.

Laryngoscope
—instrument for examining the larynx, and for visualizing airway structures in order to place an endotracheal tube within the trachea.

Larynx
—organ responsible for producing vocal sounds, which is also the passage conveying air from the pharynx to the lungs. Within it are the vocal cords. See
pharynx.

Lumbar puncture
—procedure in which cerebrospinal fluid is removed from the spinal canal using a hollow needle inserted unto the lower back.

Lumbar vertebrae
—five bones of the back.

Lymphoma
—a malignant tumour of lymph nodes.

Lytes
—refers to electrolytes, the concentration of salts within the blood.

Mac-3
—refers to a type and size of laryngoscope. See
laryngoscope.

MCAT
—refers to the Medical College Admissions Test.

Mitochondria
—molecular structure found in every living cell that is the site of energy production for the cell.

Mitral regurgitation
—failure of the mitral valve to close, allowing blood to flow backwards from the left ventricle to the left atrium. Mild cases have no symptom or consequence, but severe cases can be dangerous. See
mitral valve.

Mitral valve
—valve in the heart between the left atrium and left ventricle that normally allows blood to pass from the atrium to the ventricle but not backwards.

Mobitz II
—a disorder of the heart's electrical activity that is potentially dangerous and unstable.

Neuroleptic
—class of medications used to treat psychosis. See
psychosis.

Neuron
—cell that transmits electrical impulses to carry information from one part of the body to another.

Neurotoxic
—substance that is poisonous or harmful to neurons. See
neuron.

Nitro
—refers to nitroglycerin, a medication that promotes the dilation of blood vessels and may relieve chest pain associated with the heart.

Normal sinus
—the normal rhythm of the heart.

Pacemaker
—device used to produce and maintain normal heart rate in patients who have a heart block. See
heart block.

PEA
—refers to pulseless electrical activity, a state in which the heart has spontaneous electrical impulses but these impulses do not result in movement of the heart's muscles or circulation of blood.

Pelvis
—the lower part of the abdomen. See
abdomen.

Periodic table
—chart that details the earth's primary substances.

Peripheral line
—intravenous line that uses veins that are close to the skin.

Pharynx
—muscular tube that acts as a passageway for food from the mouth to the esophagus, and as an air passage from the nasal cavity and mouth to the larynx.

Phosphorylation
—combination of an organic molecule with a phosphate group.

Poisoning syndrome
—constellation of signs and symptoms that appear in a patient as a characteristic manifestation of the patient's exposure to a certain type of poison.

Psychosis
—mental disorder in which the patient loses contact with reality.

Pupil
—circular opening in the centre of the iris. The iris is the coloured portion of the eye.

Purkinje system
—part of the heart's electrical conduction system.

PVC
—refers to premature ventricular contraction, meaning an isolated contraction of the ventricle without the normal regulatory impulses of the heart's electrical system. Single PVCs are benign, but multiple PVCs may be a worrisome sign.

Quarantine
—period for which a person is kept in isolation to prevent the spread of a contagious disease.

Recombinant thrombolytic
—thrombolytic medication that is produced by molecular synthesis instead of by extraction from natural bacterial cultures. See
thrombolytic.