The Hour of Bad Decisions (7 page)

Sometimes, that kind of shift is a whole night of next to nothing – picking broken glass out of tumbledown drunks, and sprains that need nothing more than ice and pressure bandages. You get a fair amount of sleep, and only get woken up occasionally to write a prescription for strep throat or for painkillers.

Other times, it's flat out from the moment you get to the hospital, and every time you turn around, there's another car crash or a great huge knife wound where you have to spend a couple of hours just making sure you pick up all the nerve and tissue damage so some idiot doesn't turn around in three months and sue you silly. Sue you, because you patched him up after a knife fight, and now he's only got half a smile.

And the trombone player in the apartment next door to me is driving me mad. He's been there a month now, in addition to the people downstairs who work night shifts and put their laundry in at the strangest of times. I've complained to the landlord, but they can't seem to pin the guy down – it's like cops, they're never there when you need them, and this guy, he never seems to be playing when the landlord comes around.

At first, I thought he was right next door – I'd wake up and hear him as if he was in the room with me. But go out in the hall, and it's hard to find where exactly the sound is coming from. When I talk to the landlord on the phone, I can practically hear the shrug coming right back at me over the phone lines. I don't even think he believes me that the guy is there.

As for the trombone player himself, I don't know if he just doesn't realize how thin the walls are, or if he's trying to push me over the edge. Or whether he just doesn't care. He plays scales, fractured scales – one, two, three, four, five, one two, three, four, five – over and over again. Sometimes the same song –
Blue Moon
 – so that, for a day or two, it peals in my head like ringing bells. You must know that old Sinatra classic – “Blue moon, you saw me standing alone …” I'm pretty sure he's playing it with a mute – and that he knows just how loud the trombone is, and that he's making at least some effort to muf fle the sound. But not enough effort, because I can be in the apartment trying to sleep and he can drive me right back into my clothes and out onto the street.

The noise is so pervasive that I've made up my own image of the guy – I assume it's a guy, although I've never seen him.

I picture him as late middle aged, paunchy and standing there playing the trombone naked, with a roaring great erection. He can play naked at home – in my imagination, that gives him some kind of charge. I don't want to think what that says about my head – I'm no expert, I only spent one rotation in psychiatry as an intern, just enough to know that it was all my mother's fault. Hey, I'm kidding, all right?

For sure, though, I'm not known for my pysch skills. They brought me the guy they call the Major once, wanted me to commit him permanently. Two police of ficers, and a slew of angry firemen to boot. The Major was a favourite trick they used to play on the new guys, the probationary firefighters. The fire alarm would get pulled at the Major's nursing home, always around ten at night, and the trucks would pull up and the fire fighters would put the new guys in breathing gear and send them inside. They'd crawl up the stairs to the alarm station, and there'd be the Major. Uniform hat and jacket, one hand at his forehead, saluting.

He'd be staring at the spinning red lights flashing though the windows, and whacking off with his other hand.

Funny stuff, hey? At ten o'clock at night, maybe.

But not at three in the morning.

I told the fire fighters they were being paid to answer fire calls, not me, and why were they waking
me up for that kind of crap anyway? What did they want me to do, prescribe some ky jelly to the old geezer so the Major wouldn't light some kind of friction fire? I didn't take even a moment to consider the underlying pathologies, to ask the “what if ” question, like, what if there's a day when pulling the fire alarm isn't enough, and a bunch of old people die in their beds because the Major lights up the toilet paper in the bathroom? I thought about that for weeks, waiting to read about the fire. I probably should have sent him upstairs to see the pro shrinks – at least then it wouldn't be on my conscience if anything happened.

Maybe, just maybe, if I cared more about the “underlying pathologies,” I would have spotted Miller earlier, right? I'm rambling – I know it, but it's hard not to ramble when you're just trying to do the best you can, and all you really want to do is sleep. Ever fall asleep while you're driving? That's what it's like – you're so tired that you can feel your eyelids dropping, even though you know exactly how dangerous it is. Your head messes you up – just for a second, your eyelids say, just for a second. Coming back from a day in the country, everyone a little sunburned and sleepy, and the next thing you know you're in a hospital bed and you're alone, everyone else having died in the emergency room hallway or before the fire fighters could even cut them out of my suv.

Sorry. I'm just sorry. So I work harder, and carry crosses like this guy.

I was fading right there in the room with Miller, fading, though he seemed like a real dangerous guy to
be ignoring, even for a moment. He was telling me about his apartment, about how it was bugged, about how his knees were shot from driving and he lived above a stereo shop.

“That's what I did, see, is I took all the styrofoam from the empty boxes, just the flat sheets from in front of the screens, and I put that down all over the apartment floors, see, because it lessens the impact. Also the noise.” He was talking faster, kind of gabbling, and I was still collecting symptoms, or at least keeping track of them, checking them off as he went. Nothing I could cure in this guy, so I wanted to be rid of him – although the styrofoam, that seemed like a good idea.

Impatience – that was a big problem with me. If you can't fix 'em right away, make the diagnosis and shift 'em upstairs. That's one reason I work well in emergency – you keep them moving, and only do the magic that you're sure you can deliver.

I always thought my hands were magic – that's the kicker, really. I'd be sewing someone up – real fine work, a cut over an eyebrow or somewhere a scar would show real easily, and it would be as if I was standing back and my hands were doing the work all by themselves. Fine work, too, not the slap-dash needlepoint that some doctors call stitches – if it was someone I ran into again later, I'd always keep an eye out, to see if the scar was as fine as I expected it to be.

Not a lot of people like to work the emergency room shifts. The hours are a killer for family life, for
one, and then there's the chance of doing something wrong: get someone on the table with their chest filling up with blood, a crushing chest injury like hitting the dashboard when you're speeding along at 100, and you've got to get a tube in there and drain things before the lungs collapse.

But the emergency room is to medicine like slaughtering cattle is to working in a French restaurant – the emergency room is fast, messy medicine, and you're pushing a tube in between someone's ribs and hoping you don't accidentally do more damage in there.

It's got to be done, and quickly. Otherwise some-body's wife just dies there in the hallway while her husband's unconscious and can't tell the other doctors what they should be doing. It's best guesses, and heaven help you if you guess wrong, because even if the families never figure out what you did wrong, you know it. I always figured that if anything happened, I'd be able to do something about it – I never figured I'd be a patient, too, the kind who wakes up three days after an accident and can only remember what they tell him about it. Flail chest – all the ribs broken on one side – it must hurt like hell, but I know what to do about it, damn it, I know exactly how to put in the drain, and do it right away to lessen the stress on the lungs. That way, everything won't just shut down while she's out there lying on a gurney, waiting for somebody to get around to wheeling her down to x-ray. Enough blood inside the chest wall and the lungs collapse, away she goes, unable to even
call out to me for help. I don't let it get that far, because I don't second-guess, waiting on x-ray time.

Miller was pissing me off. Maybe, I thought, maybe I'll tell him he needs a rectal exam just for spite, or order up some particularly nasty diagnostics, just to get even for all the time he's wasting – no, no, really, doctors don't do things like that, no matter what kind of jerk you are.

And then I realize he's stopped talking, and he's just sitting there staring at me, and he has to realize that I'm not paying attention at all. And that's just about the worst thing I could do, because it's feeding the pathology – the guy already thinks doctors are the enemy, unwilling to listen, and I'm proving the point. And it's not even because I don't care. It's because I'm so damned tired that my eyes are starting to cross, and even I know that I'm a danger to patients when I'm like this.

And now I'm a danger to myself as well. Miller has picked up the knife.

The strange thing is, the only thing I can think is that I'm going to get stabbed because a trombone player wants to get a hard-on, and how fair is that?

No one from the floor had been in to see if everything was all right – sooner or later, a nurse would have to poke her head in to tell me we had a cardiac on the way – Friday night, there's always one or two, but it was near shift-change and they were probably all finishing up their paperwork.

“You should just tell him to stop,” Miller says, digging under his fingernails now with the tip of the knife. “Haven't tried that, have you?”

“What?” I wasn't sure what he was talking about.

“The trombone player,” he said.

I hadn't told him a thing about the trombone player.

“You could ask him to stop. That is, if he's really there at all.”

I lost my temper then, and banged my hand flat and hard on the countertop, the noise loud enough to startle even me.

“What the hell do you know about my life, buddy?” I shouted at him. “And what's it matter anyway? I've got better things to be doing than dealing with you.”

“I know you're pretty out there, doc. I know you're wound right up. And I don't know if you're in any shape to be treating patients.”

I just stared at him. “Is that your diagnosis?” I said coldly.

“I don't know,” he said. “You're the doc. At least I know what's going on with me. How about you?”

He grabbed his clothes with one hand, slouched down from the table, and touched me under the ear with the tip of the knife.

“I think maybe you're not a blue after all.”

Then he walked out the door of the examining room and headed down the hall. I heard him whistling in the hallway, whistling
Blue Moon
, so I must have said something about my trombone neigh-bour, but I don't remember when or what.

“
Without a dream in my heart
,

Without a love of my own…”

I sent Scott after him, the biggest orderly we have, and Scott likes to tussle. When he's off shift with us, he works downtown as a bouncer, and I've seen his hands after some weekends, the knuckles ripped up and scabbed over. I told Scott that Miller had a knife, told him to get the cops. I felt under my ear, but there wasn't any bleeding.

When Scott came back, he just shook his head. There had been a trail of footprints in the fresh snow, he thought, but only until he'd reached a busier street.

“Sorry, doc,” he said. I noticed Scott's hair was full of loose and perfect snow flakes. “No sign of him.”

No sign at all.

H
ELEN SAID SHE WOULDN'T GO – AND SHE
didn't.

“No way,” she said, not even looking up from her book. “It's just a bunch of drunks I don't know, and all their cigarette smoke and noise. I can't think of a worse way to spend an evening.” She was in their bedroom, a blanket over her legs, knees drawn up into a small but stubborn mountain range.

“I've got to go,” Kevin said, standing at the foot of the bed. “It's the Christmas party. I'm expected.”

“You're expected? It's your office. Go ahead then. It doesn't mean I'm expected.”

“Fine.”

It was, he thought, an argument they used to find time to have. But now they just walked away, positions entrenched. They had reached a point, Kevin thought, where arguments were over before they
began. It was the flash point that wasn't – it was, he thought, surrendering, giving up, letting go.

Outside, there was wet snow already. The spruce trees were heavy with it, and there was enough down on the road that the occasional cars left tire tracks that lasted only moments before they started to fill in. Pulling out of the driveway, before the tires bit down to the pavement, Kevin stepped on the gas and the back end of the truck gave a sudden shuddering lurch to one side, and for one small moment, he thought about backing up and just pulling back into the driveway. But the thought made him set his jaw, and he drove away.

Later, it would occur to him that somehow it was all her fault, just because she wouldn't go, that it would have been different if she had. And what an easy way out that was: it was his first excuse.

But he had others.

“There aren't good guys or bad guys,” he liked to say afterwards to anyone willing to listen to him talk about it. “Nothing is as simple as that. Nothing is black and white.” Just saying it wasn't his fault, that there were other things involved, that none of it would have happened if things had been going better between them.

“You don't just go out and sleep with someone else,” he'd say, defensively, as if it were some kind of legitimate explanation, as if it wasn't exactly what he had done.