Bloodletting and Miraculous Cures (24 page)

Permits are needed.

We needed to make a fuel stop in Florida. Niki wanted to connect the ventilator when we got there and just ignore the fact that Mr. Amiel had died. Fuel up,
keep on going, and arrive in Canada. She explained this to Mrs. Amiel, who nodded, wordless. Dispatch in Calgary wouldn't go for it. Once they knew that the patient had died, I guess there's no way they could allow it. In accordance with FAA regulations, we have declared that the patient is dead.

The morning stretches into flat, hot light. The Aviation Authority men meet us in a pickup truck. The constable from the sheriff's office arrives wearing tan polyester pants with a holster slung against his hip. The coroner's workers pull up in their van. The FBI agent looks like an out-of-work corporate lawyer. Jiggling belly, crisp tie, and expensive sunglasses. They take statements. They speak to Mrs. Amiel quietly, with sympathy, but there are questions to ask, and yes, there's one more person who wishes to speak to her. Each time I give a statement, I point out how much Mrs. Amiel has been through, and how much it would help her if we could fly home with her deceased husband. There are regulations, they say, that must be followed.

The coroner's workers take the body to the coroner's office, where it will be decided whether to release it or to perform an autopsy.

Some fuel stop.

 

19:15 EST—Place de Ville suites, Bahamas

Marcus, Rafael, Niki, and I are in a hot tub. The pilots are timed out. No more flying until they rest.
More regulations, and these ones I appreciate. From here, we can see the beach in its round sunset light as we sit in the hot, swirling water.

We said goodbye to Mrs. Amiel in Tampa. Her insurance firm and our flight company haggled back and forth on the phone, and made a deal with her. Something to do with money, such that it was better for her to get a commercial flight home. No point in our medical jet flying her back to Toronto. Dispatch said that we would pick up a passenger in Cuba, and should wait in the Bahamas. The embargo prohibits flying from Florida to Cuba, so we had to go via the Bahamas. After clearing customs in the Bahamas, dispatch told us that the Cuba flight was off, but we should sit tight. They would look for another paying run. I was happy that the pilots were timed out and we could rest. At the hotel, I finished off my flask, and slept through the afternoon under a big, whipping fan with no hesitation, and no dreams. Now, in the bubbling tub, the evening half-light is like a strange illusion. New plan, we've heard. Tomorrow, we fly for Chile.

We drink mojitos in the hot tub. The hotel girl brings a fresh round and says, proudly, that they grow the limes and the mint here, on the grounds.

“And the rum?” asks Marcus.

“That comes from sugar cane,” says the girl.

Rafael makes a sound like fire and laughs at me. We read out loud from a pocketbook that Niki always brings. The book has three hundred pages. Each page is
numbered with large italicized numerals, and on each page there is a question. As we go around, every person chooses a number and then must answer the corresponding question.

Rafael chooses number 168.

Niki reads, “If you had a choice between being famous and destitute, or rich and anonymous, what would you choose?”

Rafael says, “Wealth. Filthy loads of it.”

“And you can't buy the fame,” says Marcus. “It's an either-or question.”

“That's fine. I would be rich. People hate the famous, and the rich. The best situation is to be rich and unknown. When you need help, not one person will help a famous, destitute man.”

“I would choose the fame,” says Marcus. “Then you live beyond your death, and the famous always manage to live off others anyhow. Who cares if you leave bad debts? Immortality has no price.”

I drain my glass. Mint in my nostrils. The lime and sugar are emeralds melting the ice cubes.

Marcus chooses 207.

Niki reads, “You are offered the chance to live every possible dream in one year. In that year, you will do everything you ever desired, fulfill every fantasy you ever had. You will be completely happy and satisfied. When that year is over, you will die a quick and painless death. Would you take this offer, or would you instead decide to keep on living your life as it is now?”

“This is a trick question,” says Marcus. “This is really a question about how happy you are right now.”

“But what's your answer?” says Rafael.

“I refuse to answer trick questions,” says Marcus.

Niki boos.

“All right. I choose my own life, because I expect to fulfill all my desires in this life and live to be healthy and old. I'd like to stretch it out. Why all in one year?”

It is my turn. I choose Chapter 2: Take All of Murphy.

Niki reads, “Your spouse goes on a business trip far away, and has an affair. The person is someone your spouse will never see again, and this affair will never affect you in any way. Would you want to know about it?”

“Is ignorance bliss?” I say.

“Don't dance around it,” says Niki.

“Whether I would want to know depends on a lot of things. Did my spouse seduce the other person, or was she seduced? Maybe it was one of those drunken things that happens. Is my spouse apologetic in telling me, or triumphant? All these things would affect my answer.” I am unmarried, so I feel comfortable speculating.

“Drunken things that happen, you say,” says Rafael. “Then you allow that these things happen.”

“Of course they do. I saw a survey,” I say. “Half of men, a third of women.”

The bubbles have stopped, and the palm leaves above us make the sound of dry hands rubbing slowly together. Marcus pushes the button on the side of the tub, which makes it erupt again. The forceful thumbs
of air press the small of my back—that muscle pain which is about to melt into relaxation.

“How do they get those numbers? Who would tell some pollster about themselves cheating?” asks Niki.

“It's the relief of confession,” I say. “Secrets are difficult, heavy. So one day, you're making an omelette, or driving to work. Your phone rings and some anonymous person wants to know if you've had an affair. Of course you tell them. You've been waiting to tell someone for years.”

“So what's your answer?” says Niki.

I say, “I don't want to know. How could I ever trust my wife again, if I knew?”

Marcus shakes his glass. Ice. He looks around for the girl who makes the drinks.

“It's about knowing,” says Niki. Then she says to me, “But what if you had an affair, or did some horrible thing? Would you tell your wife?”

“Probably. I'd want to come clean. I couldn't carry around that secret.”

“That's unfair. You wouldn't want your wife to tell you, but you would tell her.”

“That's not the question in the book,” I say.

 

21:55 EST

I am about to fall asleep in the hot tub. Too tired to stand. The pilots have gone already. It's just Niki and me. We're pretty far gone, but we can sleep tomorrow while the pilots fly. It is night, and I love the damp
cool fingers of Caribbean evening on my face.

After a long silence, Niki says, “That woman, Amiel, she told me you said her husband got everything that could have saved him. She was glad to know that much.”

“I couldn't say anything else.”

“That's the right thing to say,” says Niki. “Nothing else needed.”

“You think?”

“Isn't that what you would want to hear?”

“Absolutely.”

I drain my glass, and the sweet mint clears my eyes, my vision. Soon we will have to stand up into the breezy sea air, be chilled for a moment, make our way to our hotel rooms with their hypnotic fans, and rest for tomorrow's flight.

 

CONTACT TRACING

November 16, 2002 (from the files of the World Health Organization)

First known case of atypical pneumonia occurs in Foshan City, Guangdong Province, China, but is not identified until much later.

 

February 10, 2003 (from the files of the World Health Organization)

The WHO Beijing office receives an email message describing a “strange contagious disease” that has
“already left more than one hundred people dead” in Guangdong Province in the space of one week. The message further describes “a ‘panic' attitude, where people are emptying pharmaceutical stocks of any medicine they think may protect them.”

 

Dr. Fitzgerald still had his watch, so on the second day of his admission he timed it. Through the glass, he could see when someone was coming, and it took them a little while to get in to him. Anyone who needed to come into Fitzgerald's respiratory isolation room had to don a second N95 mask over the one that was already pressing a red welt into their face, a clear face shield, a second hairnet, a first pair of gloves, then an isolation gown over the one they were already wearing, then a second pair of gloves, then a second layer of shoe covers. Then they would wave to Fitzgerald to make sure that he was wearing his mask securely before coming in. But this preparation time didn't count. Fitzgerald timed the minutes of human contact starting when the person entered the room, and ending when the person left. Usually, it was one of the nurses. Dr. Zenkie saw him once each day.

They addressed him as Dr. Fitzgerald even though he had become a patient. When he was alone in the room, he didn't want them to call him doctor, because it somehow implied that he should be partly floating above this illness and yet have some control over it. These were the obligations attached to the word, which
he had no energy or ability to live up to. Each time he saw a nurse begin her ritual preparations to enter the isolation room, he decided that he would ask her to not call him doctor. However, once she entered and addressed him in this way, he could not ask her to call him anything else. With someone else in the room, he became scared to give up his title, this dark-cloaked word. Suddenly, this label which felt taunting and futile when he was alone became, with someone else present, his best and last and only piece of clothing which, despite its flaws, could hardly be discarded—except for this he was now naked, stuck in this isolation room that was always humming with its dedicated ventilation fans. What would he be if not a doctor? His self before becoming a physician seemed like a half-remembered, dreamed version of himself, a persona that was impossible to resume in his present life. Although he longed to shed the medical shell when he was alone, it was frightening to try to remember how to be anything else in the presence of others.

They took his vitals, and checked his intravenous line. The fever clawed at his skin and he gripped the armrests of the chair to control the shaking while the nurse took his blood pressure. The nurses brought the food as well, so the attendants wouldn't be exposed. Then they left. Seven minutes, was what he timed each day. Seven minutes of human contact in twenty-four hours. Between these minutes, Fitz kept the television on. The same clips played again and again, and encouraged
time to evaporate. Each day, the numbers on the television mounted. One hundred and sixty-seven cases worldwide. Eight in Toronto. Thousands quarantined, and now the horrible, fascinating spectacle of new cases blooming, spreading, the numbers bursting bright on maps like dandelions on a mowed lawn after the rain.

 

March 15, 2003 (from the files of the World Health Organization)

“This syndrome,
SARS
, is now a worldwide health threat,” said Dr. Gro Harlem Brundtland, Director-General of the World Health Organization. “The world needs to work together to find its cause, cure the sick, and stop its spread.”

 

(Initial consultation note of Dr. R. Zenkie, FRCPC, dated March 15, 2003—excerpted from chart with permission of Toronto South General Hospital)

ID: Dr. Fitzgerald, 29 years old

OCC: Flight evacuation physician

CC: Cough, fever

Dear Dr. Chen,

Thank you for this consultation. Dr. Fitzgerald is a previously healthy young man who saw you in the emergency department on March 10 with four days of fever, progressively worsening dry cough, diffuse myalgias, and occasional rigours. I agree with your impression at that time that the chest X-ray appeared typical of an
atypical pneumonia. You prescribed a course of azithromycin and advised Dr. Fitzgerald to rest at home. In the following days, Dr. Fitzgerald became progressively more short of breath and noted his own tachypnea at rest.

It has since become apparent that a patient whom Dr. Fitzgerald transported from Shenzhen, China, to Vancouver, Canada, has died of pneumonia and DIC at the Oceanside Community Hospital and that Dr. Fitzgerald likely contracted his illness, which we suspect to be
SARS
, from this patient. Dr. Fitzgerald was seen again in the emergency department on March 14 by yourself, and then by myself at your request. Isolation and respiratory precautions were implemented.

Initial physical examination revealed a muscular young man with a good oxygen saturation of 95 percent on 4 litres nasal prongs, however with an O
₂
Sat of 88 percent on room air. Mild tachypnea, fine inspiratory crackles noted throughout all lung fields, with mild in-drawing and accessory muscle use. Chest X-ray reveals diffuse patchy densities and air bronchograms suggestive of widespread consolidation.

We have admitted Dr. Fitzgerald into a negative pressure isolation room. He has developed a coarse tremor. We have continued the azithromycin, have added ceftriaxone, acyclovir, ribavirin, as well as a pulse course of solumedrol. This broad regimen will be continued until there are any developments concerning the appropriate treatment of
SARS
. Dr. Fitzgerald's clinical condition has
worsened, and today he requires 10 litres of O2 by face mask in order to maintain an O
₂
Sat of 91 percent. He is somewhat anxious. Having said that, he is a robust young man who will hopefully improve, although his thoughts have become rather morbid. His coarse and bothersome tremor is not in keeping with the
SARS
picture that other centres are reporting. There are no focal deficits. Tracing and quarantine of Dr. Fitzgerald's contacts is being undertaken by the Department of Public Health. Several of his contacts have already been hospitalized.

Thank you for involving me in this timely and interesting case. I will continue to copy you on the chart notes, although you will likely not receive these reports until you have completed your own quarantine period.

Yours truly, Dr. R. Zenkie, FRCPC

Consultant in Infectious Diseases, Toronto South General Hospital

 

When Fitzgerald was admitted, Chen was quarantined as an unprotected contact. Fitz asked Zenkie about his flight crew. All quarantined, afebrile, except Niki, who had been in the cabin with him and the patient who was now Canada's first
SARS
fatality. Niki was admitted at Holy Mercy, and requiring an FiO
₂
of a hundred percent. It had been a routine patient transfer—Shenzhen to Vancouver. Pneumonia and sepsis. Now the patient was dead, which was also not outside routine, but what was new was that they were sick, they had made others sick, and the whole world was now
holding its breath while learning this new word,
SARS
.

Dr. Zenkie puzzled over Fitzgerald's tremor. This was not part of what most centres were reporting, but of course no one could say what to expect. Fitzgerald knew this shakiness. When he had gotten the fever and cough, he had figured he would blur away the time with some single malt. Probably a viral pneumonia, he and Chen had figured, but best to start the azithro just in case.

For the most part, he had kept the alcohol just below the surface—a quick shot in the back of the plane, one or maybe two with a meal, a glass of comfort before sleeping in the hotel rooms that looked the same all over the world. It was always there, but he told himself that he was disciplined about it. He paced and timed himself to the next one, and figured that as a flight doc he passed the effects off as being dazed from the time change and sleep deprivation. That and breath mints. Niki must know, of course, but Fitzgerald believed that when the tight spot came in a flight, he was up for it and sharp.

Apart from the rationed nips, the binges called him like old friends who were impossible to outgrow, who wanted to visit him on his days off. He would sink down through the first four or five that made him feel right, then swim into the next few rounds where there was a peaceful warm slowness, and then the weight of it would pull him to the bottom of the bottle where it was just one after another, automatic
as if the drinking itself would be enough. Enough for what? Enough.

This time, though, the breathing bothered him. When he drank to the point where he usually felt soft and floating, instead the numb edges were fringed with a panic. One night he dreamed that he was in the Lear jet with Ming. She was the patient, but she opened her duffle bag to reveal a newborn child. The baby was blue, floppy, and she threw it at Fitzgerald. It was a girl, mottled and cold, limbs draped down from the naked torso which he cradled. He said, “You're the baby doctor.” Ming said, “I just deliver them. The rest is your game.” Then she went to the front of the plane to chat with the pilots. Fitzgerald began mouth-to-mouth and chest compressions. On the infant, the mouth-to-mouth was little breaths puffing out a single birthday candle, the CPR was a tap-tap-tapping on the chest, as if using a manual typewriter. Tap tap. Firm. Not too hard or fast—lest the spindly metal arms with the letters on their tips become jammed. The plane dropped—a weightless moment—air pocket? Turbulence? Then a hiss, and the oxygen masks dangled from the ceiling. Fitzgerald tried to hold a mask to his face and deliver rescue breaths to the limp baby. Breathe the mask, puff the baby, but he couldn't keep it up. Too much switching, fumbling, he needed both hands to hold the baby, but one hand to grab the mask and one hand for compression. He was faint, vision clouded. Ming and the pilots chatted casually, their masks strapped to their
faces. Fitz would have to stop breathing for the baby, just suck on a mask himself. At this point, when he had decided to abandon the child but had not yet given up the baby to hold his face to the mask, Fitzgerald woke—shaking, gasping. Drank from the bottle next to his bed.

It was perhaps because he was drunk that he waited a couple more days to return to hospital. By March 14, the sparks of plague headlined news broadcasts. Public Health phoned, left messages. Fitzgerald listened to all eleven urgent voice mails that exhorted him to check his temperature, to call Public Health, to report to hospital if he had a fever or any respiratory symptoms. A man in an isolation mask came to the apartment building, and on the short-circuit monitor Fitzgerald watched him stand in the lobby, buzz Fitzgerald's apartment, pull on latex gloves. Fitzgerald didn't answer. He was drowning in lung fluids and tried to flush this away with alcohol, but even when the alcohol began to recede his lungs were still filling from illness, so he returned to the hospital. Chen was on duty, again.

And now the withdrawal. Of course, Fitzgerald had his own diazepam stash at home for the shakes, but he hadn't brought them with him to hospital. It didn't hurt anyone, he told himself, and he only “treated himself to a session” when he had some time off, and then weaned himself to that “cool place” before he was scheduled to fly again. Now he wished he had brought a bottle, never mind diazepam.