Misadventure

“How did you know it was tetanus?”

At 4.30 am I was tempted to drink a cup of tea with Mary Heenan before turning in.  I shrugged, recalling the peculiar quality of the trismus, the rictus, the risus sardonicus.  “I’m lucky.  I’ve seen two cases of full-blown tetanus before, in Papua New Guinea.  They both looked just like that guy.”  I could still remember the nervousness of the wait on the postage-stamp air strip perched on a mountain top at Maramuni; the cackle of the wind through the Pandanus trees, the monotonous buzzing of the flies in the afternoon sun, and the hot stench of the red-brown New Guinean earth.   

“Well,” said Mary, “I’m impressed.”  I swaggered off to bed.  Pride cometh before a fall.

I climbed into the sleeping bag on the floor of my office.  Light filtered through the chinks in the curtains.  I shivered and felt vaguely sick.  It was horrible, going to bed at dawn.  We had a debate one night in the Edinburgh Royal Hospital for Sick Children – “Sick Chicks” – about whether it was better to go to bed for one hour, or stay up all night.  The definitive answer was supplied by a Shetland girl who spoke with a beautiful, sing-song, almost Nordic accent.  “Go to bed and get rid of the ankle oedema.”  And what was that desperately poignant thing a prisoner in Auschwitz had said?  “How do I get rid of my oedema?  I weep it away.”

I slept.

In the exhausted, hospital semi-sleep snatched after the false dawn, one dreamed vividly.  These dreams were intense and could be remarkably coherent.  They were a combination of the rational and the surreal.  They could be monodelusional.  Somewhere, lurking within the confines of the dream, would be a stark anomaly.  This morning, my dream was all of a piece.  I entered in on it fully furnished with the prior information to make sense of it.  Dr Da Silva was a research haematologist, middle-aged, of mysterious mulatto-creole origin.  He was carrying out research under the auspices of, and with the aid of a substantial grant from a wealthy Japanese pharmaceutical company.  He was researching the oxygen-carrying capacity of various synthetic molecules.  In particular he was looking for a molecule which, while it mimicked the oxygen dissociation curve of adult human haemoglobin, was neither carcinogenic, nor allergenic, nor teratogenic; in addition, it had to be stable in plasma, and had to have certain properties of pliability, fragility, and viscosity.  In short, Dr Da Silva was trying to make artificial blood.  We were interested in Dr Da Silva’s project because we were always running short of blood.  Our patients were always running short of blood.

Dr Da Silva’s research was far advanced.  Results from experiments with an animal model were proving extremely promising.  But he had run into problems with the Medical Ethics Committee.  Meanwhile the Japanese stock market was unusually edgy, and Da Silva’s sponsors, though polite as always, were fidgeting.  They needed a break-through.  Desperate times demand desperate measures.

That was my dream’s back-story.  Where did it come from?  I have no idea.

I was standing in Resus tinkering with a Hamilton blood-warmer when Dr Da Silva floated silently in.  I looked up, and gasped.

“Dr Da Silva!  What has happened to you?”

Dr Da Silva gave me a ghostly grin, raised a white hand in a salute as from a great distance, and floated on.  I followed him through the department.

“Dr Da Silva!  Wait!”

As he passed down the corridor, two nurses standing together in earnest conversation looked up, gasped, and I saw one of them put a hand up to her mouth.  They separated to let him pass.

“Doctor!  You are so pale!”

He was, in fact, deathly white.  Yet still ostensibly Caribbean.  He looked like something out of Voodoo.  A zombie.

I followed him down the medical corridor, a few steps behind, and to his right.  I noticed he placed his steps with exaggerated care, careful not to bump into anything.  I imagine even minor trauma might have been a concern.  He could not be sure how his molecule would affect the clotting factors, the cascade mechanism.  Outside Physiotherapy, the Professor of Medicine was talking to his secretary, a well-dressed middle-aged lady, holding a pair of ornate horn-rimmed spectacles several inches in front of her eyes, squinting at a file.  As Da Silva passed, she looked up, uttered a soft, strangled scream, and dropped the file.

Dr Da Silva reached the end of the medical corridor.  I had the impression that, all the way along, his feet had not actually made contact with the floor.  He put a hand gingerly on the door handle at the end of the corridor and turned to stare at me with his sickening, bloodless smile.  “Do you think I should risk going outside?”

I thought, why not?  After all, being dead already, a zombie cannot be killed.  I said, “Dr Da Silva, are you all right?”

“Perfectly.”

But I had the notion that when Dr Da Silva had performed the exchange transfusion on himself, he had lost his soul.  Perhaps there were functions that the red calls performed, vital neuropsychiatric functions, about which our physiologists knew nothing.

Dr Da Silva passed through the door and floated across the car park.  A 1962 Hillman Minx, making its way from Occupational Health to the main hospital thoroughfare, seemed to become momentarily confused, meandered over the kerb, and slumped gently against an empty dustbin.  My eyes flickered at this minor diversion.  When I next looked, Dr Da Silva had vanished.

My locator sounded.  “Beep… beep… beep…”  I switched it off and turned to walk back down the medical corridor.

“Beep… beep… beep…”

I opened my eyes.  The room was full of pale grey light.  I reached for the phone, dropped it, retrieved it, and spoke into the ear-piece, inverted the phone, and spoke again.

“Whassis?”

“Are you awake?”

“Was mah?”

“We need you to do an arm block.”

“Fetch Dr Da Silva.”

“You there?”

“Car hit a dustbin…”

“Doctor!  Get up!  Both feet on the ground!”  Was not this how they came for you, in the middle of the night, to disappear you into the Gulag?

I pulled myself up.  “What is it?”

“Can you put in an arm block for a broken wrist?”

“Get Lawrence or Yolande to do it.”

“They’re not credentialed.”

“Get them to do an ischaemic block, a Biers’ block.”

“Come on doctor.  You know we’ve banned them in the department.”

“Oh Hell.”  I got up and staggered across to the nurses’ station in the acute assessment area, in rumpled theatre blues.   I couldn’t get Da Silva out of my head.  He’d seemed so real.  I could not begin to fathom how I’d dreamed him up.  Did he exist?  If so, who was he?  Had I invented him?  If so, who was I?

“Where’s the wrist?”

“In there.”  The staff nurse pointed.  “Here’s the x-ray.”

I gave it a cursory glance.  “It’s broke, that’s for sure.”  I checked the label.  The X-ray belonged to a certain Mr Wilson.  Resus room 3.  A placid, bald-headed gentleman sat by his bedside.

“Morning sir.”

“Good morning doctor.”  He was disgustingly cheerful.

“Which is the sore wrist?”

He may have paused uncertainly for an instant before answering, but then he lifted his right arm.

“I’ve been asked to pop the arm off to sleep.  Then I believe the orthopaedic surgeons will be looking after you.”

“You’re the boss.”

I even got him to sign the consent form.

I put the X-ray of the fractured wrist up on the viewing box, drew 40 mls of 1% prilocaine with adrenaline into a 50 ml syringe, and attached it to a 45 degree bevelled needle via an anaesthetic extension set.  I invited the patient to lie supine on a trolley, and he complied.  I brought his right arm into abduction and full external rotation at the shoulder such that the hand and wrist were lying behind his head.  I found the axillary pulse in the right axilla, and injected into the surrounding sheath of the neurovascular bundle.

“Feel a tingling?”

“Slight, in the fingers…”

“Hand’s going numb…”

“Good.”  I injected the entire content of the syringe.

“Okay?”

“Good as gold.”

I glanced again at the X-ray.  It was a Colles’ fracture, quite severely displaced, comminuted, and foreshortened.  Funny how the wrist clinically hadn’t looked so bad!  I peered at the X-ray.  I felt an insidious gnawing emptiness create itself in the pit of my stomach.  There was a large letter “L” superimposed in the top left corner of the X-ray plate.  It was an X-ray of a left wrist.  If I felt angry at Mr Wilson, it was only because I felt twice as angry with myself.   But how could he lie there and let me anaesthetise the wrong limb?  Did he think we were performing some esoteric therapeutic manoeuvre at a remote site?  What did he think I was?  An iridologist?  Only one thing for it.  It’s always the same in medicine.  If you make a mistake, own up.

“I’m terribly sorry.  I’ve numbed the wrong arm, Mr Wilson.”

I bit my lip.  He nodded comfortingly at me, and said, without rancour, “I’m not Mr Wilson.”

“Beep… beep… beep…”

This time I woke up in a cold sweat.

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