survivor.

 

                                    

Survivor

                The phone rang shrilly, as I sat at my desk writing

 notes on the patient I had just seen.  I picked it up.

            "Dr. Smith?" A  female voice.

.           "Yes," I said.

            "Could you come out to the house and check the baby?"

 the voice had a flatness, an indifference, that a more

 experienced physician might have recognized as a warning sign.

            It was ten in the morning, I was running late and still had

 four patients waiting in my waiting room.  It was my first week

 in practice, and it was different to be solely responsible for the

 patient's care. Frightening to know, or at least to think, that

 your every decision might be a life and death issue. Difficult to

 make decisions quickly, difficult to know how to handle simple

 non medical issues for which medical school and internship 

had not prepared you.

            "What seems to be wrong?" I asked.

            "The baby has diarrhea," Mrs Y. answered tersely.

            "How bad is it? How many times a day ?

            "Oh, I don't know, he just seems sick. Are you coming out?" she asked.

            "yes, " I said, "I'll be out as soon as I've finished seeing 

my patients in an hour or so."

            "Okay," she said, gave me the address, and hung up.

 It was one of those bright, hot, prairie days, under a radiant

 blue sky.  It was about two hours after the phone call as I drove

 northward through the city, into progressively seedier

neighborhoods.  I finally identified the house.  It was a small

 wood framed house that had once been green. That much 

could be deduced from the occasional green chip of paint that

 was still adherent to the wood.  The small front yard was

 overgrown with weeds and strewn with garbage.  The front 

door was slightly open and when I tried to ring the door-bell

 there was no sound.  I could hear a baby crying inside the 

house.  I tried rapping on the door with my knuckles, but still no

 response.  I pushed the door open and walked inside. 

            The stench was unbelievable. The house was strewn with

 every type of litter imaginable.  Dirt in every corner, crusts of

 bread, paper, dirty clothes, unwashed dishes, toys, garbage.  A

 baby was crying, I assumed it was my patient.  I worked my way

 toward the kitchen and opened the door.  Inside, a four or five

 year old boy had opened the refridgerator, and seemed to be

 eating at random.  He looked grubby, his face smeared with

 food, and a purulent discharge running from his nose.  A dirty

 little girl was trying to drag him over to the table to no avail.

           A door opened and a fat, unkempt young woman with

greasy looking hair slouched into the room. 

            "He's in there," Mrs Y said pointing to another room. 

            I felt anxious, for a moment.  I had expected to be

 directed to another room where I had heard the crying coming

 from. Even though I had visited many slums before, and as a

 student did many home deliveries in the slums of Dublin, I felt

 peculiarly uncomfortable.  I walked into the room to which she

 pointed, which was as grubby as the rest of the house.  She

 pointed to a crib in the middle of the room.  Under a pile of

 dirty covers lay a small body, white, with a sort of yellowish

tinge to its waxy skin, motionless, its limp form not much bigger

 than a ragged doll at the bottom of the crib. I pulled back the

covers, horrified. Could the baby really be dead?  Surely not in

this day and age. How could this have happened?  Was it my 

fault?   Maybe if I had dropped everything and came to the

 house as soon as she phoned I could have saved this little life.

            Although the baby was obviously dead, I senselessly went

through the ritual of performing a physical examination on the

 little body.  Or perhaps not so senselessly, for what does ritual

do more than give one an opportunity to reflect on the present

 situation and give one an opportunity to collect one's thoughts.

            "I'm very sorry to have to tell you the baby is dead," I said.

            "Oh," she said, as though all this had nothing to do with

 her, "What do I do now?"

            This was my first week in practice in Canada.  Nobody in

 medical school ever taught me what to do about anything like

 this.  After all, medicine is all about saving lives, relieving pain

 and suffering, not disposing of dead babies.  I did know enough

 to know that unexplained deaths had to be reported to the

 coroner. From the next room I heard the sister call to the small

 boy "get away from the fridge, Gary, you can't just keep taking 

food any time you want".

            " I have to call the coroner," I said, embarrassed to have

to mention such a thing.  "I think there will have to be an

 autopsy, so you will have to bring him down to the hospital."

            She didn't seem perturbed, as though nothing had

 registered at all.

            As I walked out of the house I glanced back.  My last 

glimpse was of little Gary, being pulled away from the fridge by

his sister, two twin tracks of yellow-green snot, running down

 his upper lip, delicately poised at the slightly upward

 incline,where the white skin met the pink.

 

            Doctors have been trained to take a lot of responsibility

even for things they are not responsible for, and as I drove back

 to the office that afternoon I felt, quite unrealistically, that

perhaps if I had only dropped everything and run straight out

there maybe I could have saved that baby.  As I walked up to

my office I stopped at the office of one of my senior colleagues,

whom the clinic had selected as my mentor.  They did this to all 

the 'newbies' as it's easy for a new member to get lost in a clinic 

of sixty doctors crossing all the specialities.

            "What are you looking so grim about?" he asked me. 

           Jamie was a wirey, lean guy, kind, but with a short temper

that went well with his clipped Canadian accent.  He had been a 

fighter pilot in World War two, and somehow looked it.  He

usually had a carton of cigarettes on his desk, or in his hand,

and when he had his heart attack a few years later, he got into

his car and drove down to the emergency room and walked in

 saying, "I'm having a heart attack, someone better do an ECG."

 He was right, he was having a heart attack.

            "I just made a house call on a dead baby," I said.  "If I

 had just run straight out when I got the call, maybe I could have

 got the kid into hospital and we could have got some fluids into

 him and saved his life, but he didn't sound that bad over the

 phone and the mother gave me no idea how sick he was."

            "How long was it between the phone call and the time you

 got out there?" he asked.

            "A couple of hours," I said.

            "Perfectly reasonable," he said, "you know perfectly well 

there was nothing you could have done.  You responded 

perfectly reasonably.  Why don't I give the coroner a call on your

 behalf. I know the routine." 

            Although I never had a chance to repay Jamie for his

 kindness and support, over the years, many young physicians

 benefited from his kindness.  He called the coroner, put me in

 touch with the appropriate social services, who went out and

 visited the home, decided the parents hadn't the skills

 necessary to look after children. Not that they were deliberately 

cruel to the children, they weren't.  The children were placed in

 foster home, I was informed later.  From time to time I thought 

of little Gary Y, no regular eating hours, just foraging through the

 fridge whenever he felt hungry, and that last glimpse I had of

 him, the snot running down his nose, his sister, not much older

 looking after him.

 

            Many years later, one of my duties was as medical officer

 for a high security psychiatric prison.  I was seeing patients

 regarding their general medical conditions, when a young

 man came in to see me.  He looked vaguely familiar, and I

 asked him where he was from.  He mentioned the  city I had left

 some 15 years earlier, so I looked to see his his surname.   

 It was Gary Y.

(The crime for which he was imprisoned was non violent and

he was being mentally assessed prior to his court appearance.)