CHAPTER 1 THE EVENT May 13, 1999, was bright and promising, or so I thought. The smell of new grass was in the air. It was the type of day you waited for all winter. I got up and had a shower, not knowing that it would be the last time I would have a shower for months. I packed my golf clothes in my sports bag and headed downstairs. I ate my regular cereal while I marvelled at the glorious day that awaited me. I talked to Jenny, my dog, and then climbed into my truck without a care — and without a thought about what I would soon consider a dream: the ability to drive. Soon I was heading down the highway for the hospital. I was a family physician who had been in practice for twenty years. I enjoyed my life. I took pleasure in the patient-doctor interaction and liked the variety of complaints that a family physician sees. The one thing I never enjoyed was the constant time stress inherent in this work. There was always the need to balance giving enough time to each patient and seeing everyone who wanted to be seen. But after twenty years, I think I had moulded my practice to ďŹ t my personality.
S h a w n J e n n in g s This was to be a special day: I was taking the afternoon off for a golf game. An afternoon with no phone calls, no thinking about diagnoses, no questions to answer; nothing but easy banter with my buddies and a nice walk on a pleasant day. The golf itself was secondary to the social interaction and the surroundings. With this on my mind, I headed into the hospital. I made my rounds without incident. All of my patients were doing as expected. One of the last patients I saw was Pauli, an unfortunate lady in her early sixties who had scleroderma, a progressive disease that would soon enter the terminal stages for her. Scleroderma is caused when too much collagen is laid down in the tissues of the affected body part, which causes a fibrosis, or stiffness. The skin loses its elasticity and normal cells are displaced. The cause for this excess collagen is unknown. She had been well, looking younger than her age, until about five years before, when this insidious disease started. It had progressed at an alarming rate. At first it caused the skin on her hands to tighten. Her fingers were unable to bend and the skin had split open over her knuckles, leaving open sores that wouldn’t heal. Then the skin around her mouth tightened, causing a loss of expression and difficulty with speech. Her legs became involved, making walking impossible. Next the disease started to work its way into her digestive system, stealing her ability to swallow or digest food, and she had chronic diarrhea. The week before, we’d had to insert a gastrostomy tube into her stomach, bypassing her mouth and esophagus, to give her nutrition in the form of a liquid supplement. I had been torn by this decision, as the supplement would prolong the inevitable. I was sure that what life remained to her would be of poor quality, filled with pain and suffering, but she had made my decision easier with her wish to keep going. Finally, in what I believed was going to be the final straw, the disease had started to affect her kidneys.
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Lo ck e d I n Lo ck e d Ou t To complicate things further, she had experienced a stroke when the disease had spread to her blood vessels. In addition to paralysis, the stroke had caused aphasia, or damage to the areas of the brain involved with language, hampering her ability to communicate verbally. Her family had been very supportive. Her husband had kept her at home as long as he could until the diarrhea, immobility, and other factors led us to admit her to hospital. When I went to see her that day, she had just been moved from an active ward to this chronic care ward. She would be the last patient I would see. “Good morning, Pauli,” I said. “Aaaa,” she responded as best she could. “Did you have a good night?” “Mmmmm, Au ha soo diaea,” she tried to say. “Some diarrhea?” I guessed. “Aaaa.” “Did you take the MCT oil with your meal last night?” MCT oil is a substitute for butter or margarine that is easy to digest. “Ugh!” She grimaced. “Well, I’ll have to look at your chart to see if there are any meds that maybe we should look at. What did they give you to eat last night?” As soon as I said it, I knew this was a foolish question. How could she respond? “Sorry!” I said sheepishly. She chuckled. “I’ll ask the nurse.” I proceeded to examine her hands, which were grossly contracted, like a bird’s claw, and just as delicate. Her mouth was drawn back, exposing her upper teeth, but she could still smile, as she was doing now. I carefully lifted up her pyjama top so I could see her gastrostomy tube. It looked to be healing just fine, despite the scleroderma. “Be good!” I said. She nodded, and I strolled away to examine her chart. After I had written my progress notes and typed my
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S h a w n J e n n in g s orders into the computer, I left the floor. I left the hospital quite quickly and jumped into my truck. Rolling down the windows, I breathed in the fresh air — no air conditioning for me today. As I neared my office, I looked out at the clear blue sea beyond the harbour and once again marvelled at the day. Just the morning to get through and I would be free. I drove into the parking lot at my clinic and turned my head to back up. It was approximately 9:00 a.m. As I turned my head, a peculiar sensation hit me: my vision started to move backward and forward. My ears began to ring. Vertigo! I thought. The McDonald’s sign across the street shifted back and forth. I noticed a man sitting in his car beside me. Hope I don’t make a fool of myself! I was due to start in the office now. I felt I couldn’t walk, so I called my wife, who worked as a nurse in my office. I was lucky she was there, because she usually didn’t work on Thursdays. She later told me that I was doubly lucky, as there was no battery life left on my cellphone after that call. My receptionist answered the phone and I asked to speak to Jill. “I won’t be able to make it in,” I said. “I’m awful dizzy!” “Where are you?” Jill said, alarmed at the concern in my voice. “In the upper parking lot.” I don’t remember much about the next few minutes until I saw Jill in front of my truck. She found the door open and my seat belt unfastened. I don’t remember doing this, but I vaguely recall feeling hot, so I may have opened the door for air. I again told her that I was dizzy. She felt that I should go to the hospital and helped me out of the truck. I staggered over to the back seat of her car, which I had happened to park beside. Having great difficulty arranging myself into a comfortable position, I thought this was a really strong attack of vertigo.
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Lo ck e d I n Lo ck e d Ou t Jill drove around to the other side of the building to tell my receptionist and my patients, who had already arrived, what we were doing. While she was gone, I realized I was going in and out of consciousness. I also started to think that this was more than vertigo. My right hand was feeling heavy and numb. I became aware that my breathing was laboured. My lips were pouting and I could almost hear myself snore. I felt I should stop this, straighten up, but weariness overcame me. Sleep would feel so good. Jill was gone but seconds. When she returned, she was alarmed at my condition. I could hear her asking me questions. I wanted to respond, to tell her about my hand, to tell her what I suspected was happening to me, but when I tried to speak, all that came out was a garbled “mmmm.” As she drove to the hospital, I became more unconscious. As if in a dream, I could hear her imploring me to keep talking and stay awake. My only response was a deep groan or a snore. My final moment of awareness was in front of the emergency department. I saw and felt a male nurse and an orderly, both of whom I knew, lift me out of the car. I heard someone say, “We just saw him this morning!” That was the last thing I heard as I lapsed into the sleep I seemed to need so desperately.
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