Terminally Ill Page 2

  Chapter 2

  My jaw dropped. “Oh, no, he isn’t!” I said, unconsciously channelling every black sister in a sitcom.

  Tucker burst out laughing. “I was wondering when that would get a rise out of you!” He rubbed my back, circling my scapulae, before he let his hand drop.

  I twitched my shoulders, trying to ignore how he made me feel. His eyes dropped to my chest, so I crossed my arms over my breasts in case I’d gotten what one of my friends called T.H.O.’s, or “titty hard-ons.”

  “Quiet!” said one of the med students, a guy with thick brown hair and thicker glasses speckled with dandruff. We all leaned in to listen to the newscaster.

  “Elvis Serratore, the twenty-year-old escape artist from Winnipeg, will attempt to escape from this vampire-like experience on—you guessed it—Hallowe’en. Tomorrow afternoon, come down to the Old Port to see Elvis in chains, at 1:23 p.m., the day and time that the great Houdini died 85 years ago. Elvis lives, at least for now. Back to you, Brian.”

  “Isn’t that amazing?” said Tucker. “Don’t you wish we could just take off and watch him tomorrow?”

  I stared at Tucker. His brown eyes shone brighter than a bride’s, and his short blond hair looked flatter than usual. Maybe he’d forgotten his hair gel because he was so thrilled about Elvis. He was still watching the TV, even though the news had switched over to the weather report: rainy and cold, thank you very much, although I suppose we should be grateful it wasn’t snowing yet in Montreal. One up for climate change.

  The rest of the crowd whooped.

  “That guy is badass!” said Sébastien.

  A med student, a delicate-looking blonde, shook her head. “More than that. He knows what he’s doing. My cousin is from Winnipeg, and she’s seen Elvis do the Houdini water escape from a tank. She almost cried. He’s not just some poser who’s doing a publicity stunt.” She poked her plastic soup spoon at Sébastien’s face for the last two words, as if she wanted to enucleate his eyeballs.

  I kept my distance from her. Med students with pointy objects can be dangerous, even if they don’t want to remove your eyeballs on their lunch hour. I pulled my sandwich out of the fridge while they argued whether or not Houdini was the best escape artist ever and everyone else should just give up now.

  “Even if Elvis knows how to get out of chains,” I said slowly to Tucker, between bites of my cream cheese sandwich, “how’s he going to get his hands and feet free fast enough to break open a coffin that’s nailed and chained shut, and fight his way out of a freezing cold river?”

  “That’s the art of escaping,” said Tucker, rubbing his hands together. “Man, I love that stuff. I used to do card tricks, but this is big time.”

  I paused. Tucker was always surprising me. I had no idea he loved magic, but now that he mentioned it, I could see him as a little kid dressed in a miniature tuxedo, making a twitchy, pink-nosed rabbit appear in a hat. But I digressed. “Not for me,” I said, turning toward the door. The residents’ room was starting to feel oppressive, and not just because of the usual smell of rotting spaghetti.

  “Hope, c’mon. It’ll be fun.” He followed me out the door.

  “So have fun.” I bit into my Royal Gala apple. It was starting to go soft, but residents couldn’t be choosers.

  As soon as the door shut behind us, he lowered his voice. “Are you on call tomorrow for internal medicine? You could call in sick.”

  I stared at him before I remembered to chew and swallow. “In case you’ve forgotten, I can’t afford any sick days.” I had missed way too many work hours after not one, but two murderers, tried to off me.

  Tucker had the grace to blush, although he didn’t drop his eyes. “I didn’t forget. You’re not supposed to take any days off. But they can’t help it if you’re sick, right? And you’re on palliative care. Who’s going to miss you?”

  I shook my head. “I can’t believe you’re saying this.” I was on call on Sunday, not Saturday, but playing hooky was as foreign to me as diving in the Seychelles. As the palliative care resident, I covered internal medicine call on nights and weekends.

  “Hope, I’ve lived in Montreal my whole life and I’ve never seen an escape artist. Elvis is only doing it here because Houdini almost died in Montreal. You know that story?”

  I shook my head again, checked my watch, and headed for the central set of stairs. I had six minutes to climb three flights and make it back to the ward to meet Dr. Huot, the palliative care specialist, at 1 p.m. “Yeah, yeah. Something about a McGill student punching him in the belly. I never understood that.”

  Tucker pushed open the staircase door for both of us. “He hit him before Houdini was ready for it. Houdini was lying on a couch and the guy started pummelling him before he even got up. Houdini was already in bad shape. He’d fractured an ankle when they were hauling him upside down in a pulley, for his water torture cell escape, so he was wearing a splint and a leg brace. I guess Houdini was slow to get up from the couch and didn’t have time to tighten his abdominal muscles for protection, like he usually would. He performed anyway that night, but he spent the intermission in a cold sweat. He still managed to finish his performance that night and the next, but when he took the train to Detroit—”

  I stepped up my pace on the last flight of stairs. Somehow, I didn’t want to hear about Houdini’s suffering, even though it was so long ago.

  “—he was in agony. Terrible stomach pain. He shook with chills for half an hour. Still, he was determined to perform his show. He climbed on stage with a fever of 104 degrees Fahrenheit.”

  I had to smile as I punched open the door at the fifth floor landing. Only a doctor would feel the need to clarify that it was Fahrenheit, even though it obviously wasn’t Celsius. Even Harry Houdini couldn’t survive if the water in his cells started boiling away at 100 degrees Celsius. Still, I was hooked on the story.

  Of course, Tucker grabbed the door and stopped right there, door open, with a smirk bigger than any of Gaspard Ulliel’s, this French actor that one of my roommates used to crush on.

  “So what happened?” I said to Tucker. Belatedly, I lowered my voice, since we were less than five feet from three different admitted patients’ doorways.

  Tucker grinned and leaned against the wall, ignoring the soiled laundry bins lined in the hallway across from us. “He performed. Collapsed at intermission. But he managed to get up and finish the show before he blacked out again.” Tucker paused. “The next day, they took out his appendix. It had ruptured. They gave him an ‘experimental serum’ and opened him up again on post-op day four, but sepsis swarmed all over him. He told his brother, ‘I can’t fight anymore.’ And he died on October 31st, at 1:23 p.m.”

  I said stupidly, “I thought he died in Montreal.”

  “Nope. A good ten hours away, in the motor city. But a lot of people blame Montreal, because the guy who punched him here might have ruptured his appendix.”

  I frowned. The appendix is just a long, skinny tube of flesh attached to the large intestine, but it often gets blocked and infected, either stoppered up by a fecolith (a tiny ball of poo) or lymph tissue. I’ve never met or heard of a patient who ended up with appendicitis after trauma, although I hadn’t looked it up, either. “Do you think that’s likely?”

  Tucker opened his mouth, but before he could answer, I glanced behind the bulky palliative care secretary, whose desk faced the hallway, and spotted Dr. Huot sitting at the nursing station table. It’s bad news if the staff beats you back from lunch, so I whispered, “Gotta go.”

  “Knock ’em dead,” he said, which was kind of a bad word choice, considering all the murders I’d been mixed up in, so I made a not-quite-obscene gesture at him and took a seat at the table.

  Dr. Laurence Huot set her fountain pen beside the chart. “It’s good to see you, Dr. Sze.” She beamed at me, pleased with her own wit: most people pronounce Sze just like the word see.

  “You too, Dr. Huot.” I wished I’d brought my water. I felt dehydr
ated and over-examined by Dr. Huot’s hazel eyes, which were magnified by her tortoiseshell glasses. I was trying not to say anything about her haircut. Overnight, she’d gotten her prematurely grey hair trimmed into a severe bob just above the ears. The bangs, cut razor straight well above her eyebrows, reminded me of the times I’d tried to trim my own bangs.

  “We have a few minutes to do some teaching about some common problems in palliative care,” she said in her moderate French accent. “What is your approach to constipation?” Every time she asked a question, she punctuated it with a radiant smile, like the angels were touching down in front of her, which feels a bit weird when you’re talking about laxatives.

  I avoided her eyes. “Well, you know. I usually use Colace. I know it’s not that effective.” But almost everyone tolerates the ubiquitous translucent red capsules.

  She beamed at me like I was a particularly clever and adorable baby. “Docusate sodium! The stool softeners.” She wrote that down on a blank piece of paper. “Now. Which other ones do you use?”

  “Metamucil.”

  She glowed at me. “Wonderful. Psyllium seeds and other fibres, such as methylcellulose and calcium polycarbophil, can work well, as long as the patient is well-hydrated. Which other medications do you prescribe?”

  “Senekot.”

  She nearly chortled with glee. “The stimulant laxatives can be very effective, although chronic use can be associated with hypokalemia. What else?”

  “Um, lactulose?”

  “This is a different class. Lactulose is a sugar, so it draws water into the bowels through osmosis.” She wrote that down too, in big, loopy handwriting. Slowly, painfully, we made our way through the classes of laxatives. “Now, don’t forget basic bowel hygiene. The most important things are to increase fluid and fibre intake. Have you ever noticed, in the morning, that after you eat, you must go to the bathroom?”

  Now that she mentioned it, absolutely. I stared at her with round eyes.

  “The gastrocolic reflex,” she said, writing the words with a fond and tender smile, as if she’d rescued a newly born kitten. “Now, you may keep this paper for your files.”

  “Um. Okay.” I don’t keep too many papers around, but I could transcribe the notes on to my computer.

  “Then you may go see our newest patient, Mr. Bérubé. He is a patient diagnosed with end stage lung cancer.”

  “Thank you, Dr. Huot.”

  “No, thank you, Dr. Sze.” She bent over the wheeled wire rack of patient charts and handed me Mr. Bérubé’s. “When you finish, we can review your case and drink fresh coffee.” She bestowed one last beatific grin on me as she pointed at the teeny staff room on the south side of the nursing station, which was barely big enough to hold a coffee pot and a sink, but somehow they’d managed to cram a microwave and two chairs in there as well.

  “That’s very kind of you, but I don’t drink coffee.” I’ve never had staff offer me a beverage. More proof that Dr. Huot was not of this world.

  I read the chart quickly. His small cell lung cancer had spread to his liver, bones, and brain. His wife had brought him to the emergency room complaining that he was up all night and prone to falls. One of the emergency doctors, Dr. Chia, had diagnosed him with a low sodium caused by his cancer, so we were slowly correcting his sodium levels, as well as employing the pain management and constipation remedies I’d started learning in my first week on palliative care.

  I nodded at Ricky, the palliative care secretary, as I took a right out of the nursing station. She pushed her glasses up her nose and picked up the phone, ignoring me.

  I have a terrible sense of direction, but even I can’t get lost on the palliative ward. There are only eight beds, but each room is private, a luxury in this day and age. Palliative care takes up one small wing of the fifth floor, which is otherwise swallowed up by the active internal medicine ward.

  I headed to room 5656, on the left side of the hallway, just past the central staircase that Tucker had recently run back down. For a second, I braced myself for Tucker to throw open the staircase door and say, “Boo!” but I guess he had to get to his clinic, because I passed by unmolested.

  I pasted a smile on my face and knocked on the open door. Before this rotation, I had only a vague idea what “palliative care” meant. Basically, we try to reduce or prevent patients’ suffering. Dr. Huot pointed out that the term comes from the Latin term palliare, to cloak, because we’re helping cloak patients’ symptoms. It’s what most of us do in all branches of medicine, whether that’s offering ibuprofen for a headache or setting a broken arm. But palliation means you’re only helping instead of curing. And most palliative patients are at the end of their lives, and most are cancer patients.

  When I entered the room, an elderly woman was shaking out a quilt, an amazing conflagration of vibrant red, blue, green, and yellow swirls on a black background.

  “Do you like the quilt? I made it for my husband,” she said. She tucked the quilt expertly around the patient, Mr. Bérubé, who was lying on the single bed in grey, button-down pajamas and matching slippers. He coughed twice.

  Mrs. Bérubé held a tissue up to his mouth. “That’s right, get it all out, my darling.” She folded the tissue over his sputum expertly, tossed it in the garbage, and turned to me with a smile.

  “Hi, I’m Dr. Hope Sze. I’m the resident doctor on palliative care. I just wanted to say hello.”

  Mrs. Bérubé took my right hand in both of her warm palms and gazed deeply into my eyes. “You’re a good one. I can tell. You’re going to be lucky, eh, Papa?” she called to her husband.

  Mr. Bérubé closed his eyes and sagged into his pillow, which crackled under the weight of his head.

  Mrs. Bérubé made a face. “I hate those pillows covered in plastic. I’ll bring him one of his own, from home. I forgot to bring it, I was so excited that he was getting his own room, and even a private room.” She leaned forward to whisper, “We’ve been in the emergency room for almost four days!”

  “My goodness,” I said. Montreal emergency rooms get notoriously jammed up, worse on weekends and holidays, and I think it’s longer waiting for a bed in palliative care because it’s a specialized service. I tried to change the subject. “At least you brought his quilt.”

  She smoothed it with her palm. “Well, this is just a little thing to remind him of home.”

  It did make a difference, though. Instead of the usual box of a room with the fake wood dresser on wheels and a speckled tile floor, the quilt felt like a brave flag of independence. I’d never paid much attention to quilts, but this one somehow reminded me of the coats of arms in George R.R. Martin’s Game of Thrones series, all bright clashes against the encroaching darkness.

  “That’s not the most important thing, though. I brought his lucky silver dollar.” She pointed to the dresser, which she’d corralled into service as a small bedside table.

  I spied a coin gleaming from the depths of a case lined in black velvet. I nodded and opened my mouth to ask about Mr. Bérubé’s pain. The chart said the pain in his back was the worst, especially since he lay down all the time now.

  “I won that silver dollar for a public speaking contest for the entire school,” said Mrs. Bérubé. “You can hold it, if you want.”

  Well, maybe they were tired of talking about cancer and pain all the time. I took a few steps closer and peered at the coin politely.

  “Go on, touch it.”

  “Oh, I wouldn’t want to…”

  “Go on.”

  Some people say that drinking together helps bonding. Maybe the next best thing, on the palliative care ward, is admiring a patient’s treasures. Anyway, I like coins. I picked up the silver dollar. It was bigger than a toonie, our two-dollar coin, and more solid. And, of course, it was silver. It gleamed in my palm as I read the year, 1935.

  “I was eight years old,” she said, eyes twinkling. “Now, a woman is never supposed to tell her age, but I suppose when you’re in this situation...”
Her eye fell on her bedbound husband. His chest rose and fell softly, but his eyes stayed closed. “It doesn’t matter so much anymore.”

  I nodded. I was probably supposed to say something deep and meaningful now, but I was fresh out, so sympathetic silence would have to do. I carefully replaced the silver dollar on the dresser.

  “He was two years older than me, and so handsome! All the girls wanted him, but I just pretended not to see him. I kept my nose in the air and I worked hard like I was supposed to. Of course, I wore pretty dresses, and I’ve always had long legs. George noticed me from the very beginning.”

  I smiled. I thought she was still beautiful, not just her high cheekbones and the bow of her red lipsticked-lips, but the force of her personality. We should all be so lucky at—I paused to calculate 2011 minus 1927. Wow. She was 84 years old. “How wonderful,” I said. “Well, as I mentioned, I’m the resident doctor from palliative care. So I wanted to check on Mr. Bérubé’s pain levels.”

  “He’s asleep,” she said, turning to look at him. Sure enough, he had dozed off, even though a shaft of sunlight fell on his pillow, illuminating his wrinkled face. “His pain is usually under five out of ten now. When we came in, it was an eight or nine. I think his sodium is normal at last.”

  “Almost. It was 132 yesterday.”

  “The doctor thought it was close enough, and we could just restrict his fluids. I can do that.”

  “I’m sure you can. It looks like everything’s under control here. I’ll come back for Mr. Bérubé’s physical exam.” We’re not supposed to disturb palliative patients, which means minimizing nuisances like bloodwork and waking them up. Kind of the opposite of the emergency room, where he just came from, and where I plan to practice.

  Mrs. Bérubé smiled at me. “I think everything’s going to be all right, now that we’re finally upstairs. Good thing I brought his lucky silver dollar!”

  I paused in the doorway. “I thought it was your silver dollar.”