Bloodletting and Miraculous Cures (22 page)

 

2:05 EST—St. Therese Hospital

Garcia takes us through the front doors into the dark lobby, where a sleepy security guard looks up from his wooden chair. He swings a flashlight at us, nods, and turns it off. The lobby is high-ceilinged, with curving stairs at one end leading up to a second-floor mezzanine. All of this I glimpse in a single arc of the guard's flashlight.

Our stretcher loaded high with gear bags, we follow Garcia through the front building into the courtyard. Between the buildings are walkways roofed with corrugated tin on vine-covered stilts. Between these paths are swaths of grass, the tips going to seed and waving in the courtyard breeze. We ride up the clanking elevator and trundle down a dim hallway.

Outside the intensive care unit, a woman with peeling shoulders sits cross-legged on the floor. Her two greasy braids of sand-coloured hair hang heavily over a blue flower-print dress. Next to her is a knapsack. It is as if she has been kidnapped from suburbia, and in her captivity she listens to a portable tape player.

“Mrs. Amiel?” I say.

She looks up. “Are you here for Franklin?” she asks. She speaks loudly above the headset.

“We don't have much time. The airport will close,” I say.

Mrs. Amiel nods as if this is perfectly natural, that the airport would be on the verge of closing just as we arrive to transport her comatose husband. Niki introduces herself and Garcia. Mrs. Amiel takes off her headset and smiles. She says, “Spanish tapes. I'm trying to learn. There's no hospital tape, though. It's all about ordering beer, and how to describe the colours of dogs.”

“We're going to speak to the local doctor and move your husband onto our stretcher,” says Niki.

“Everything is in Spanish,” she says. “They are kind,
but everything is in Spanish.” Her smile is hard and dead, speaking the voice that she is trying to keep sharp.

“Garcia will help us,” I say.

Mr. Amiel glows under the lamp at the head of his bed. Another three beds like his are in this room, each a shrine to care surrounded by pumps, poles, tired nurses, and the sleep-deprived Dr. Manolas. Mr. Amiel's blood pressure is 65/45, which is a good pressure for a newborn baby. Temperature is 41.8. Hot. I rub his sternum with my knuckles, and he arches his back very slightly. I squeeze his big toenail between my thumb and my pen, and there is the slightest withdrawal of the right leg. The toenail begins to bruise. Garcia translates for Dr. Manolas, the intensivist: Mr. Amiel had a bradycardic near-arrest the day before and was given atropine. Blood pressure is in his boots, even with the dopamine drip. With the back of my hand, I feel Mr. Amiel's hot, dry skin. His tongue protrudes slightly from his mouth to the side of the taped-in breathing tube. One pupil is bigger than the other, and neither of them wink at my bright flashlight. Probably he's already coning: the brain swells and squeezes itself to death in the back of the skull. The smell of skin as it melts into a hospital bed is a rank scent of jungle decay, slightly sweet. Niki checks the lines and the vent settings.

Garcia translates: Mr. Amiel came into hospital still talking, but too dizzy to walk. He was vomiting from the dizziness and unable to drink. Initially, the CT scan
of his head was normal. His nausea was treated and he was given fluids. Over several days he became more sleepy, then confused. Three days ago he became comatose, and was diagnosed clinically as having a hemorrhagic stroke.

“And the subsequent scans?” I ask.

“Unavailable,” says Garcia after asking Dr. Manolas.

“The scanner has stopped working.”

“And the fever—it has been investigated? Urine? Blood cultures?”

Garcia speaks to Dr. Manolas. After talking back and forth, he says, “They say the fever is due to increased pressure in the brain. They placed a device—a Thompson bolt—in his head, but they have removed it because they cannot send it with him.” So that's why the head is bandaged.

Dr. Manolas shows me a careful record of Mr. Amiel's intracranial pressure. Big spikes, like cliffs. Too high, too fast.

Through Garcia, I ask Dr. Manolas about details, bits of information framing therapeutic pitfalls that he and I both understand. He is intelligent, well-read, and knows that the treatment has not been as modern as his reading. I make my professional sympathies evident and say that I am impressed with the clarity of the flow sheets in the chart. I ask if there has been consideration of neurosurgery. It took a day to get a neurosurgeon three hundred kilometres away to discuss the case on the phone, says Dr. Manolas, and by that point Mr.
Amiel had already blown a pupil. Also, it is hard to appeal to a neurosurgeon without a recent CT, he says. We do not say it directly, but we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact. I say that this is an unfortunate case, and that obviously Dr. Manolas has done everything in his power. He speaks in Spanish, looks at Mr. Amiel and then at me. Garcia says, “Dr. Manolas's heart is broken to see that a man is lost far from home.”

In the hallway, where the only light leaks from patients' rooms, I ask Mrs. Amiel whether she understands the situation. “He is physically delicate,” I say. I try to continue, to explain specifics. I want to clear my conscience by mentioning the proximity of death.

She interrupts me, saying, “Yes, I know. I completely understand the situation. I understand.” She nods quickly. “The insurance company didn't want to fly him. Said there was no point.”

“But finally they agreed,” says Niki.

“We're still negotiating,” says Mrs. Amiel. She must be a kind woman, because
negotiation
is a kind term. “In the meantime, I borrowed the money against our house. I'm glad we own a house.”

I know what she's paid, and her ardent triumph at having covered this bill shows that she can't afford it. Used to own a house, I think.

“I'm sure that's what he would want,” says Niki.

“It'll be touch and go,” I say. I was about to tell her that he may die at any moment, and that even if his physiology stabilizes, he's beyond the point where she'll have her husband back. I can't say that now, because the money issue embarrasses me.

As we bump into the elevator, the gauze pad falls off his right eye. The eyelid falls open in a slit, and the eye stares suddenly at me, showing its sleeping world of white conjunctiva and black pupil. I slide the eyelid shut and retape it. Niki and I watch the lines and monitors as we trundle out of the elevator, down the walkway, toward the courtyard. Dr. Manolas pulls the foot of the stretcher. We've got to get in the air, I think. They haven't radioed. I suppose that everything is fine, but we can't be caught on the ground. There's a fire on the other side of that ridge, I tell myself abstractly, as if it will disappear as soon as we take flight.

 

2:55 EST

The courtyard has a pungent grass-dew scent. The dark hospital windows around us are empty eye sockets that cannot watch, cannot see the way we now walk lopsided, the straps of the heavy bags pulling at our shoulders. Our patient is belted into the stretcher. Niki walks alongside him and every few seconds she squeezes the firm rubber bag that pumps air into Mr. Amiel's lungs. It is the kind of bag that reinflates on its own, that pops back into its original shape.

As we lift the stretcher into the ambulance, I catch the distant burnt cake smell. Dr. Manolas helps to pull the stretcher up, and a sudden guilt comes over me. Fire burns what it touches. I say to Garcia, “Tell Dr. Manolas that we saw a fire from the plane. He should know, so he can see what needs to be done. There are many patients here.”

Garcia seems confused, but speaks to Dr. Manolas in Spanish. Then Garcia says to me, “Dr. Manolas hopes to see you again one day, and would like to visit your country. He asks for your email, and prays that God will keep you safe.” Niki is in the ambulance, and I heave the end of the stretcher to push it toward her. Garcia says, “You should give this doctor something, as a courtesy. It will be good for you, if you come back here some day.” In the dark, broad leaves slap each other in a random, syncopated rhythm. Niki gestures to the Guatemalan ambulance driver about the way she wants monitors placed, lines hung. I zip open the wallet of company money, pull out fifty dollars and give it to Dr. Manolas. Garcia climbs into the front seat. He talks into the radio, and Niki yells at me to get in. “We must go,” says Garcia, “there is little time.”

I give Dr. Manolas my card with email address, which follows the money and slips like water into a pocket.

“There is fire close by,” I say in English, and make gestures that are meant to represent flame. Doesn't he understand me, if he reads English medical journals?

“Dr. F,” calls Niki, “airborne in twenty.”

Dr. Manolas laughs and holds out his hand. He must be happy with the money and my email address. Our palms slap together, we shake, and all around us the leaves that I cannot see make a sound similar to our hands meeting. I smell a sugary smoke. Does no one else notice?

“Get in!” says Niki.

Dr. Manolas didn't seem to understand my flame gestures, so I make sounds like burning. Maybe it's better to go. What can he do, even knowing that there's a fire? At that moment, I decide that I have said all I need to say. I jump in, and the door closes with a cheap tin clang. Only once the ambulance rushes down the driveway and lurches up the road do I feel like I have abandoned a friend.

Mrs. Amiel is in the ambulance's fold-down seat. Our equipment bags are piled high beside the stretcher. As we swing around a corner, the heavy red oxygen case falls on Mr. Amiel's legs, and he does not flinch. I pull it off quickly. Mrs. Amiel does not react in any way—her face is as wooden as her husband's legs.

As we drive, she recites her calculations to me. She has weighed the sums and circumstances with forced rationality. In the rhythmic way she tells it, I can see that she has done the arithmetic many times. She says, “I thought to myself, I can fly him out now, and maybe at home he'll have a shot at getting better. Or I can wait here. He's not getting better here, and if he dies I'll
have to fly the body home anyways. Insurance doesn't pay for bodies.” The insurance company refused to fly him out while he was still talking, because they said he was getting the same care he would get in Canada. He didn't need another CT scan, they told her. Once he was living on machines, they said that they wouldn't fly him out because he was brain dead, and there's no benefit in medevacing a brain-dead man. “They say I could pull the plug and he would never know. The last thing Franklin told me was that he wanted to go home, and I promised him I'd try, so I can't turn off the machines. How long could I stay here, then? No further ahead, sitting here? No way, so I called my bank.”

The ambulance dives slightly as it charges into a puddle, and water sprays the windows.

“You were here for a vacation?” says Niki.

“On the motorbike. Two-month trip—the idea was to ride to Argentina. We've been on vacation for two weeks, well, just one I guess. Second week in hospital. He thought we should do it before we had kids. Today I sold the bike for almost nothing.”

All around is black, shifting shadow. The ambulance lilts drunkenly in the turns, and I keep my hand on the red oxygen case.

“So, Niki,” I say. “Looks like a bleed.”

She nods.

There has been no CT scan proving this, but every disease has its rhythm, its dancing sequence of steps and turns that acts as a coded storyteller. The pressure in the
head tells it, the pupil of one eye wide, the worsening day upon day, the mention of an episode in which the heart slowed—bradycardia—and almost stopped.

 

3:15 EST

The last stretch of uphill switchback road. The ambulance tires spin the gravel on the shoulder. As we approach the airport, the gates of the chain-link fence roll to either side. The plane is precisely where we left it, but facing down the runway, and the pilots stand chatting with the driver of the fuel truck. Seeing us, the driver climbs into the tanker. Its upright exhaust pipe shakes as it starts, and he swings it neatly away toward the hangar. Marcus looks our way and taps his watch. We back up to the airplane.

“Are you almost ready?” says Garcia, as we delicately unlock the stretcher bearing Mr. Franklin Amiel and his assortment of lines, tubes, and wires from the ambulance to move him across the few feet to the plane. Some of the airport workers stand around us, in their jackets, holding briefcases. “I don't think they will really close, but are you almost ready?” he says.

“Ten minutes,” I say.

Garcia slaps shoulders and jokes with the airport staff. They laugh politely, but in their tiredness they do not appear anxious to make allowances for one plane which has appeared in the night to fly away with one foreigner. Garcia takes our passports from the man with the military cap. Niki and I pause, check
the passports in the rear lights of the ambulance, and button them in our pockets. I am now afraid to mention the fire. The night is a cool black, and we seem to be at a moment of delicate balance, a moment when we need to walk the suspended narrow bridge of time and step onto the stable earth on the other side of the chasm with our patient airborne. Around us is darkness, and the shuffle of bats' wings above the plane. I strain at the slight suggestion of smoke.

It's not simple to move a critically ill man. It might seem that it would be like moving a parcel, or shouldering a big, warm duffle bag. But it's not, because the tubes and lines splay from every orifice, drape the sides of the stretcher, threaten constantly to be kinked and cut off or tugged out of position. The functions of moving air, of regulating fluid, of voiding urine, which a healthy man keeps secret and neat within closed skin and barely refers to while going through life occupied with desire and philosophy, become visible external concerns. How much urine output? What are the lungs' tidal volumes? Niki has her hand on the endotracheal tube as we slide him forward. I watch it also, for this is the crucial tube that breathes. We move Mr. Amiel slowly, pull the front of the stretcher out, allow its folding legs to reach down and touch the ground. Slowly, forward, now the rear legs of the stretcher fold down. Rolling, easy, and now in the corner of my eye there is a line too straight, plastic pulled tight.