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Opinion

Attack of the Super Bugs

John MacLachlan Gray's memoir of the innards life of a Canadian baby boomer. The final chapter.

By John MacLachlan Gray 17 Dec 2014 | TheTyee.ca

John MacLachlan Gray is a writer/composer who lives in Vancouver. Among his wide-ranging works are the renowned play Billy Bishop Goes to War co-written with Eric Peterson, and mystery novels including Not Quite Dead. His blog is here. Find his previous articles for The Tyee here.

[Editor's note: In yesterday's second installment of this three-part medical memoir, our narrator's short-lived recuperation from minor bowel surgery had ended with a bite of smoked salmon and then a sudden, doubled-over surrender to stomach pain, sweats and a conviction that some potent poison had taken hold of his fate. He was therefore whisked by ambulance back to the hospital, where we pick up the story.]

A procession of science columns drifted through my mind, one after the other, about new antibiotic-resistant bacilli known as "super bugs." One of them did in my friend Michael Mercer, the screenwriter, who contracted a super bug during treatment for water on the knee; he ended up losing his kidneys, and remained on dialysis until he died. Ah, memories.

There's a weird dissonance when you enter any hospital, between the reception staff and what we might call the orientation staff. In the first instance, I sat in a tiny office with a woman at a desktop computer, who collected my Care Card, my date of birth, my current address. I remained bent over with my head nearly touching the tile floor. This was never mentioned. You might have thought I was booking a stay at the Ramada Inn.

If reception seemed cruelly indifferent, the same could not be said of orientation. Past the double doors, I entered a carwash, an assembly line of symptom collection by a team trained to work at a pace that was not rushed but not slow either. They told pretty good jokes, and more important, laughed at mine.

The lab results arrived with unnerving promptness, followed by another round of symptom collection and microscopic observation. When the results came in, the ambulance took about two minutes to arrive.

In the back of the ambulance I shared writing tips with a paramedic who was working on a novel. It took my mind off the fact that they were moving me to Vancouver General because the UBC Hospital lacked the equipment or expertise to deal with my case.

The vehicle came to a painful halt, I was lifted out on a gurney and my fellow novelist wheeled me into downtown Emerge -- which could have been Syria after a bombardment, patients in every nook and cranny, leaving an alleyway scarcely wide enough for my gurney to pass.

Lying there, I was treated to a tracking shot of Humanity In Crises. No age, gender or race went unrepresented -- waiting, waiting, waiting in their cots, their loved ones jammed against the wall nearby. Amazing how soundly some people can sleep under a fluorescent glare that would do credit to Shoppers Drug Mart, not to mention the sounds of coughing, moaning, weeping, cajoling; staff trying to get through to the hard-of-hearing and to communicate in English with someone who doesn't speak English; patients revealing intimate details about bodily functions, or complaining about the "service," or propped up alone, tearfully explaining something on an iPhone.

But not me. After confirming my name and birth date I was installed in, of all things, a small private room. We gingerly shifted my bulk from one gurney to another, then Dr. S, Dr. J and a nurse named Janet appeared as though they had been waiting in the wings: If number one is comfortable and ten is unbearable, where would you put your pain level on a scale of one to 10?

If this were an airline it would be First Class service -- priority boarding, followed by champagne and orange juice in a comfy, spacious seat. However, in my case the passenger was not Super Elite but Super Sick, and my special treatment included drinking a cocktail of 7Up mixed with chalk, then a trip to a CT scanner manufactured by Siemens (the company that ran concentration camps during the Second World War), an enormous white plastic doughnut that would create a cross-sectional photograph of my belly. According Dr. S, they were looking for an "abscess."

The process was quick and painless, and I remained in relatively good spirits, making a game of remembering the first names of the nurses. Then I logged on:

... The ionizing radiation in the form of X-rays used in CT scans are energetic enough to damage DNA.... Such damage to the DNA occasionally leads to cancer. The estimates of harm are based on exposures experienced by those present during the atomic bomb explosions in Japan during the Second World War. -- Wikipedia

The 'situation'

Nurse Janet wheeled me to an elevator, then to an empty double room in a section of the hospital called the Burn & Trauma Unit. Later I learned that the unit took patients when the Intensive Care Unit was full. Extra staff were available because after a house fire or explosion, burn cases arrive in packs, and with each patient it takes a good half hour to make sure they don't die.

Assisted by Sylvia, the night nurse, Janet rolled me off the gurney onto a hospital bed; then they shoved an IV and something else into my veins, wrapped a blood pressure monitor around my arm, took a vial of blood from another vein, turned on a machine, and disappeared.

I noted the bathroom door, the large clock on the wall, the tubes sprouting from my arms, the machine winking in the dark, the window over the empty bed next door, the sodium glow of street lamps, the silhouettes of leaves, the sound of tires on pavement, the occasional honk. The outside world seemed unreal now. Amazing how a person can adapt to a strange new world and call it normal. For example, I now found it perfectly normal that everyone entered the room in a long blue smock and matching rubber gloves.

My new chrome stork, holding more upside-down bottles than the last one, presented a raft of new challenges. When I staggered to the bathroom, my tubes tended to get tangled; they were part of my body now, like the tentacles of a squid.

In came Dr. S, a young resident from Quebec with luminescent ivory skin, who said she had been present at my bowel restructure all those years ago, and that my surgeon would arrive to talk about the "situation."

Did this sound like a good sign? Not to me.

Dr. A entered with the same earnest, precise expression I remembered from our previous meetings, and the first thing he said was that he was sorry. Whether apology-sorry or sorry-bad-luck I couldn't tell, but in either case, when your surgeon is sorry you will probably be sorry too. He explained that the CT scan had shown nothing, but that I had an antibiotic-resistant blood infection, whose identification meant growing a specimen, which would take 24 hours. In the meantime, they would continue to pump fluids, acetaminophen and a selection of antibiotics, just in case something clicked.

Left by myself, a little voice inside said: This could kill you. I heard that same little voice when I had pneumonia, and it makes sense that the brain would know when the body is threatened, and say so -- not as a wailing siren but a quiet murmur from within.

Antibiotic resistance is a form of drug resistance whereby sub-populations of a micro-organism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multi-drug resistant (MDR) or, more colloquially, superbugs. -- Wikipedia

My body got no benefit from my antibiotic cocktail; but that didn't mean it was resistant to their side-effects. Most of those had to do with the digestive system; and together with my recent surgery it brought about something more than "a certain urgency." Try it yourself: make it to the toilet, wheeling a chrome coat stand with tubes and wires that readily become tangled -- and God knows, if you detach from your machine you might flutter to the floor like a punctured balloon.

The manoeuvre takes practice, meaning trial-and-error, and each error results in the most humiliating mess you ever saw -- and wouldn't you know, the night nurse (either Lanaia or Chelsea) was young and beautiful. At times like these the little voice -- This could kill you was answered by: Yes, please, at once...

Most cases of septic shock (approximately 70 per cent) are caused by endotoxin-producing gram-negative bacilli... it causes a toxic reaction, with the sufferer developing a high temperature, high respiration rate and low blood pressure. This may lead to endotoxic shock, which may be fatal. -- Wikipedia

The bear

Next morning I opened my eyes to see that a curtain had been drawn between me and the other bed -- that I had a roommate. Listening in on his conversation with a nurse, I gathered that Dave had had skin transplants, and that on a scale of one to 10, his pain had reached 11.

Over the course of the morning I learned about Dave's misfortune: In a hunting camp in the bush, having shot a bear, he was in the process of boiling the bear's head in order to make something artistic with the skull when in a moment of carelessness, he dumped a vat of boiling bear fat on himself (fat has a higher boiling temperature than water), and had been airlifted to the Burn & Trauma Unit, where he would be spending the next several months.

Dave spent the day in a drugged slumber -- fine with me, I didn't feel like talking either. Every so often, nurse Fiona came in to take more blood and write more numbers as we awaited news from the lab. Meals were liquid, with an entree of orange Jell-O. My mate arrived with toiletries; my son brought music and ear-buds; I listened to the Black Keys and the Zolas and stared at the clock.

My next night nurse was Zsuzana, a motherly Russian woman so emotionally engaged with the patient that she nearly wept with joy when she brought news: the lab had identified my invader as gram-negative bacilli -- antibiotic-resistant, but there was a cocktail available in-house; they wouldn't have to fly in an antidote from Zurich or someplace. Zsuzana and my mate hugged briefly, looking like members of the Blue Man Group after a great show.

Night in a hospital is a little like flying the red-eye from Vancouver to Halifax: dark, lonely hours sweating in the semi-dark, too tired to read. You adjust the back-rest; you squirm into a comfortable position only to find it torture in five minutes; you listen to distant bells, cries and snores. This particular night livened up considerably when Dave began to hallucinate.

Patients on morphine sometimes say they have insomnia, visual hallucinations and nightmares. -- Wikipedia

Dreamland

Around 3 a.m., Dave began to mutter, then to speak, then to yell. The initial complaint was that he smelled cigarette smoke, that the nurses were smoking (he could tell because he smoked himself); then that they were taking drugs. He could hear them giggling. They were giving him drugs he shouldn't be taking, trying to addict him or possibly to do him in because of what he knew.

In came Fiona who looked about 16, and who adopted a tone of deliberate calm to enunciate what I'm sure was a script: that they are here to help him, not harm him, that he was experiencing a waking dream. Dave seemed to sense a falseness in her tone and threatened to tear off his bandages. Fiona begged him not to, then hurried to the nurse's station down the hall.

I had never glimpsed Dave behind the curtain, yet knew he was a man who hunted bears for fun. The voice behind the curtain now began to elicit my support, like Fletcher Christian on the Bounty: Are you with me, John? You can see what they're doing! Are you with me?

I took the coward's way out and began to snore.

Next moment, Dave was on the phone to his elderly father hundreds of miles away, demanding that he drive to Vancouver at once and pick him up at the front door; that this was a bad, bad place; that he would have contacted the RCMP himself, only they could be in league with the hospital.

At this point Fiona returned with two men I couldn't see: one had the voice of security, of physical power withheld; the other was calm, humorous, brotherly, the voice of a shrink. Between the two of them, they persuaded Dave to allow Fiona to give him something, and he went to sleep.

The antibiotic cocktail worked. (Otherwise I might not be writing this.) My condition improved, my temperature dropped. It would have to remain normal for three days before they would let me go home. I began to receive regular meals instead of orange Jell-O, though I can't say it was an improvement. My mate brought me sandwiches, and while she was at it, a sandwich for Dave, who wouldn't stop apologizing for hallucinating on morphine.

Three days later, Dr. S says I can go home. We shake hands, and I am surprised at the warmth in her blue plastic gloves. The moment I put on my own clothes, my mind switches to the usual station -- the channel of what-if angst and why-did-I-do-that recrimination, my daily clutter of small worries and complaints. Leaning on my mate, I walk these shining hospital corridors for the last time -- at least until the next ker-chunk; this parallel world in which people are made fit for the one we live in; a world where math and science are the law of the land, yet imbued through and through with what Orwell called "common human decency" and what Confucius called "human heartedness" -- the awareness that as human beings we may occupy different steps, but we're all on the same stairway.

Find (and share) John MacLachlan Gray's entire Tyee series "A Certain Urgency" by clicking here.  [Tyee]

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