The Left Atrium · De l'Oreille Gauche

CMAJ 1999;161:732-5

• Blood, sweat and tears
• The eye
• ER nights

[Contents]

We crash into the Atlantic Ocean, shattering, and I remember my mother's greatest fear and think that today it has been realized. My poor mother. When I was a newborn, while kissing my cheek, she suddenly felt the enormous weight of motherhood descend. The payment for such joy was to be the terrible risk of loss. Mothers live with that. She once told me that if anything ever happened to me she would want to be dead. Something has finally happened and she will never be the same again. I miss her already.

The water is cold and thick. When I was nine years old, my mother gave me a gold chain. It is ripped from my neck; my clothes are shredded by a sea enraged. At impact our jaws are broken, our arms and legs severed, our feet crushed. Our hands peel, sinking to rest at the bottom of the ocean. A hundred pairs of transparent gloves, waiting to be recovered. Skin floats everywhere, a new form of jellyfish, seemingly harmless. But no one will be untouched. We are pushed inland, the ocean knowing we will be needed by those left behind.

Our remains are wretched. By the time we roll in my body is nothing more than strands of muscle, tendon, a patch of skin clinging to my cheekbone and eye socket. One blue eye is miraculously intact. The rest of me has merged with the ocean, submitting. But I must return. My mother will want what is left, when she knows.

I feel hundreds of people on the beach, crying, searching. Not one of us is identifiable. Boats grumble away from the shore, carrying divers who will dredge the bottom. Rumbling footsteps pass as others forage, picking up what they find and putting it into bags. A young man in a green uniform and black boots kneels on the rock where I have landed. A military man, he looks closely, peering. Carefully, he picks me up with gloved hands, the warmth of him through the latex a comfort. When his tears come he turns his head away to prevent them from touching me. But I have come from the sea; his tears would be more soothing than the cold I feel now. He is pale and harrowed. He looks sick. Then I realize: this is no longer an emergency. It is a disaster. He cries as he holds me and walks, looking for others. Finally, he puts me into a glass container for safekeeping. I want to tell him that I am safe but my thoughts are slow and I can no longer voice them anyway.

The divers return, their faces crumpled with fatigue and hurt. They look beaten as they carry full nets onto the sand where they lay out their catch of human remains. The daunting task of trying to match the parts will begin, except there is no template for a hundred people in a plane crash. I am shocked by the violence of my departure. Who will be responsible for bearing the bad news to so many families? Who will tell my mother that her only child has gone, only a cheek and eye remaining to confirm her death?

All the body parts are taken to a morgue. I am placed on a wooden shelf next to another jar with something fleshy that I can't make out. I wonder where exactly we are. I remember the pilot talking about the coastline and the altitude of the plane. My memories are fading, useless snatches coming in unconnected threads. Death appears to be a gradual tuning out, a slipping beyond. This must be why people say, "He passed away." I always thought they just didn't want to say, "he died." It sounds so final, unlike a passing, which sounds more like a journey, taken for some unspecified time. How do the living know that, when they are intact, breathing life, vibrant with all their joys and miseries, so not dead? I can feel myself passing away. But not yet. There is still my mother.

The jar is lifted from the shelf and a white-coated woman carries me into a small room. She takes me out with forceps, sharp but they do not cut my already ravaged skin. I wonder why she is so gentle. She places me on a sterile green towel where I wait. There is nothing else now, only waiting.

A man comes into the room wearing tight latex gloves, beige, smooth, perfect. I can almost see his skin through them, but not quite. He looks about fifty. He has patient dark eyes, crinkled at the corners, intent upon me. I can see his pores, the veins on his nose, lines on his face emphasizing full lips. He is careful, slow moving, with fine fingers that sort through the pile of x-rays on his desk. He picks up each one and then looks at me. Finally, he takes an x-ray of the one tooth that refused to be torn away by a greedy ocean. This, then, is how I am identified.

When I was seven, the dentist told me I had Brody's syndrome. My teeth didn't come together in a perfect bite. At night, lost in dreams, I ground my teeth until they were one-third their normal size. I wore a night guard clamped on my teeth for six years. Lots of metal followed, always restraining, caging my wild mouth as if it would tear apart anything in its path. Upon my release, I felt light, free, as if I could just open my jaws and never stop. All those x-rays telling me who I was, now telling the world.

The man sighs and leans back in his chair. He is both relieved and anxious. Restless, he stands and I see all these feelings moving in his face. He whispers, "Oh God" as he moves to the telephone across the room. I see him mouth my name into the phone and request that my family be notified. I want to tell him that there is only my mother. He hangs up and comes over to me. Delicately, he picks me up and returns me to the jar. Back in the refrigerator, I wait. It is a long time before anyone comes again.

The door opens and the cold light alerts me to the presence of the white-coated woman. She has, it seems, come for me. We return to the room where the man with the patient eyes identified me. The woman places me on a counter beside his desk. I see him pacing. He looks uncomfortable, like someone carrying a great responsibility. I see my mother enter the room and realize that he is.

He gestures for her to sit in one of the green leather chairs that attempt to make his office more inviting. She sits at the edge, unable to relax. This is not a social visit. Her blue eyes track him as he walks the room, trying to find the right words for her. But he doesn't have them. They both know why they are here. She has come to take me home. She has come so that she can finally comprehend that I am dead. Tentatively, he touches her arm, trying to offer comfort as he guides her over to me.

She stands in front of me, tearful while he explains why I am only an eye, a cheek, a tooth. She cries as she picks up the jar. As her tears drop I know she is thinking it should have been her. She takes off the lid, hesitant. My mother holds me in both hands. She examines what little of me there is left, making sure that it is really her daughter. When she focuses on my eye, she knows. It is the colour of her own, unusual in its watery blue.

Slowly, she lifts me to her lips and kisses my cheek, soft. I know now that we will go home, one last journey before I leave her to her loss and she to mine.

Patricia Rockman, BA, MD

Dr. Rockman is a family physician in Toronto.

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[Contents]

Night shifts in the emergency department of the Lethbridge Regional Hospital are usually busy to begin with and then taper off by 3 am. After 3 o'clock the department often calms down until the flow of patients picks up again around 6 am. During these quieter periods I'd bring out my camera, set up the tripod and take pictures of anything and everything in my place of work. Anything, with the exception of staff or patients. That particular dimension of illness and injury unfolds repeatedly on the front pages of the papers, in photo essays like The Knife and Gun Club, and on television shows like ER.

"Advance directives." From Vincent Hanlon, ER Nights

In her critical analysis On Photography (1977), Susan Sontag writes: "To photograph is to appropriate the thing photographed. It means putting oneself into a certain relation to the world that feels like knowledge — and, therefore, like power." I had no desire to put a camera between me and my patients in order to capture on film their various states of dependency and need. Despite the absence of people in the photos, in many of the images a human presence can be detected within or just outside the borders of the picture.

I wanted to document the physical structure of my workplace and, especially, the inanimate objects that fill this space. An artifactual record of a hospital emergency department or, for that matter, of a post office, café or classroom could be valuable as a cultural or historical document. I also admit that making such a record is not an objective enterprise; it involves considerable selection and manipulation of the space and its contents.

My visual perspectives on the ER include extreme close-ups, wide-angle shots and multiple exposures. I deliberately used the camera's technology to recreate a sense of the confusion, unreality, depersonalization and disorientation that is often a part of the emergency ambiance for staff and patients. Initially I debated whether to make black-and-white or colour images. I decided to do both because the environment and the activity in it have real and metaphorical splashes of colour, mixed with black, white and a lot of grey.

Two problems soon became apparent. Four in the morning is a time when most of us, including me, run out of gas. I found it difficult to shift my point of view in this very familiar environment. Some nights I was too tired to analyse the scene, to switch from a doctor's concern with shortness of breath, chest pain and croup to a photographer's preoccupation with highlights, ƒ stops and visual design. It was less a challenge of switching between left brain and right brain than one of engaging in night brain activities.

"Night creature." From Vincent Hanlon, ER Nights.

The institutional fluorescent light was another problem. It reduces contrast and renders everything flat, similar to the way I felt at that time in the morning. I chose to throw any additional light available on my subjects: I used operating lights, x-ray view boxes, the ophthalmology slit lamp, flashlights, the television and a camera flash to increase the contrast necessary to make some of the photos more lively. Often the light source became the subject.

Some nights, after bringing out the camera and tripod, the paramedic phone would crackle to life with the story of an elderly person who'd fallen, or an intoxicated young man fresh from a fight would arrive in the company of his concerned chums. Sometimes I never got the camera out at all. But at other times I'd spend twenty or thirty minutes taking and retaking pictures of stretchers, thermometers, steel bedpans, defibrillators, telephones and computers, suturing equipment, notices posted on various walls, blood tubes and IV bags, the empty chairs of the waiting room, the sliding doors, trays of partly eaten meals and the ubiquitous clocks with their slow-moving arms.

"Instrumental." From Vincent Hanlon, ER Nights.

From the five or six hundred photos I took during the night shifts I worked in 1996 and 1997, I collected a few dozen pictures of this intriguing hospital landscape into an exhibition entitled ER Nights. The series was first shown in April 1998 at the International Conference on Physician Health in Victoria, BC, and was on display in September of that year in the theatre gallery of the Lethbridge Public Library.

Vincent Hanlon, MD
Lethbridge, Alta.

For the remainder of 1999 most of the ER Nights images can be viewed on the Web site of the Canadian Association of Emergency Physicians at www.caep.ca as part of The ABC of the ER, a collection of twenty-six short meditations on emergency medicine. A spoken arts CD including a book of The ABC of the ER texts and the ER Nights photographs is scheduled for release in November.

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© 1999 Canadian Medical Association