She looks at me askance as her index and middle fingers carve a pair of scare quotes into the air above her head.
“Stretch the truth a little bit?”
“Okay, I’m going to lie.”
Switchboard puts the call through.
“Hi, this is Luba at the Pink Elephant Detox Centre speaking. How may I help you?”
“Hi Luba, this is Dr. Gray calling from the ER. I have a patient here I’d like to transfer to your facility.”
“Certainly. What’s your client’s name?”
“Rocky Emesis.”
“ Rocky Emesis?”
“Er, yes. Are you familiar with him?”
“Extremely. When was his last drink?”
“Um… I don’t think he’s had anything so far today.”
“What condition is he in right now?”
“Not too bad.”
“Would you mind holding for a minute, doctor?”
“No problem.”
The instant I’m put on hold, some god-awful Perry Como-esque lounge lizard tune starts playing. Whoever invented muzak should be drawn and quartered. My mind drifts. Luba must be discussing the case with someone higher up the food chain. Does that mean she suspects I’m bullshitting her? I cross my fingers and continue holding.
Nearly a minute later she clicks back on.
“I’d like to speak to the client, please,” she says.
Oh crap. Is the Rock Man coherent enough to pass a detox phone screen?
“Um, I think he’s in the bathroom right now.”
Pretty lame, but it’s the best I can do on the spur of the moment.
“He’s not vomiting, is he? We definitely do not accept clients who are actively vomiting.”
How about if they’re passively vomiting?
“Oh no, he’s not vomiting, he’s just having a pee.”
“So he’ll be out shortly, then. I’ll wait for him.”
I jog over to Rocky’s stretcher. He’s fast asleep.
“Rocky! Wake up!”
“Eh?”
“I’m trying to get you a bed at the Pink Elephant. Come talk to the nice lady and tell her you’re okay.”
“Feel kinda pukey.”
“Just tell her you feel all right!”
“Okay, okay.”
I drag him over to the phone.
“Hi, Luba. This is Dr. Gray again. Here’s Rocky.”
I hand Rocky the phone. Is it just my imagination, or does he look a little green? Must be the fluorescent lights.
“Hello?” I hear Luba say.
“Huurr… .”
“Hello?”
“Huuurrrraaaalp!” replies Rocky as he covers the telephone with more Pop Tarts and Big Macs.
I guess I’ll be admitting him after all!
Alanna’s Birth
On the evening of June 2, 1993, Jan went into labour. The next morning our eldest daughter, Ellen, was born. Everything went smoothly.
On September 3, 1994, our second daughter, Kristen, arrived. Once again there were no complications.
By mid-October the following year Jan was two weeks away from the end of her third pregnancy. Over the preceding two weeks she had noticed a slight reduction in fetal movements, but it hadn’t been enough of a decline to concern us. On the morning of October 21 the baby stopped moving altogether. We contacted Miles, our family doctor. He was partway through a 24-hour shift in the emergency department. He asked Jan to come in for a non-stress test. To our relief, during the test the baby stirred a little. There wasn’t much beat-to-beat variability, though, so Jan was admitted for induction of labour.
By suppertime the Syntocinon drip was producing regular contractions and active cervical dilatation. At about 7:00 p.m. we started to see a few late decelerations. They made me jittery. I don’t do obstetrics, but I know late decelerations can sometimes be a sign of fetal distress. Half an hour later an artificial rupture of membranes was performed. The amniotic fluid that gushed out was nearly black with meconium. Our baby was in trouble.
Switchboard was asked to put the OR team on alert. As Miles deliberated over whether or not to proceed directly to a C-section, one of the ward nurses rushed into the room to show him a rhythm strip from an inpatient who was complaining of feeling light-headed. His heart rate was only 30, and his blood pressure was 75 systolic. Miles and I looked at the tracing together and concluded he was in complete heart block.
I knew exactly what he was thinking: This can’t wait. Now he had a second critically ill patient to deal with, and we were the only two doctors in the building. On the monitor behind Miles I could see our baby’s heart rate was taking an extraordinarily long time to recover from the last uterine contraction. I caught Jan’s eye. She looked scared.
“How about if you take care of Jan and the baby and I’ll go treat this guy in heart block?” I offered.
“Good idea,” he said. He turned his attention back to the fetal heart monitor. I abandoned my wife and followed the nurse back to the cardiac patient’s room.
First we started him on a dopamine drip and titrated it up until his pulse and blood pressure improved. We then attached the external pacemaker to his chest and tested it to make sure it would work properly if we needed it in a hurry. Once that was finished I got on the horn to the internist on call at the Timmins and District Hospital, which was our closest referral centre. He agreed to insert a transvenous pacer as soon as we got the patient down to their ICU. I called our ambulance attendants and asked them to start working on transfer arrangements. When I hung up the phone and turned around, Miles was standing in the doorway. The look on his face said bad news. He gave it to me straight: “The baby’s heart rate dropped down to 60 and stayed there. I’ve scrambled the OR team and we’re setting up for an emergency section.” My guts went ice cold.
I went into the operating room to spend a few minutes with Jan before the surgery. My colleagues were bustling about setting up equipment, but the only thing I could hear was the beep…beep…beep… of the fetal heart monitor. It was agonizingly slow.
Our regular anaesthetist was out of town that day, but fortunately for us a retired GP-anaesthetist in the community bravely volunteered to put Jan under. When he was ready to begin the induction, Trish the charge nurse shooed me out of the room.
“Go on now. Today you’re a dad, not a doctor. I’ll call you when we’re done.” It felt strange leaving the OR and hearing the sliding doors snap shut behind me.
This I learned later: Dr. Hill quickly cut through the layers of tissue until he got to the uterus. He opened it up, reached in and began to pull. Several seconds passed and still no head emerged. He kept working at it. Nothing.
“What’s wrong?” someone asked.
“Stuck.”
He continued struggling. Sweat beaded on his brow. Eventually he muscled the head out. It was purple. The baby’s eyes were closed. She wasn’t breathing.
“Cord’s around the neck. Damned tight,” he muttered.
He strained until he was able to pry the noose-like cord encircling her neck and wriggle it over her head. She remained limp and unresponsive.
“Another loop,” he said as he removed a second strangulating coil of umbilical cord from her neck. “And another. And another!”
The cord had been wrapped around her neck four times, choking her every time she tried to move. He hauled the rest of her flaccid body out of the uterus and cut the cord.
Miles grabbed the Ambu bag and started ventilating her. While he bagged, Catherine, a nurse who often helped with neonatal resuscitations, listened for a heartbeat. It was barely detectable. She immediately began chest compressions. They worked together feverishly. Moments later the Ambu bag shattered into half a dozen pieces. Catherine and Miles stared at each other, wide eyed. This was unprecedented. The equipment is tested regularly.