The Left Atrium · De l'Oreille Gauche
Practice pieces
Wardlife: the apprenticeship of a young writer as a hospital clerk
Andrew Steinmetz
Véhicule Press, Montreal; 1999
188 pp. $15.95 ISBN 1-55065-121-8
This slim volume, the first book from a young Montreal writer, is sure to appeal to physicians. The setting is first the ICU and then the emergency department in a Montreal teaching hospital. The author introduces himself: "I am the unit co-ordinator. The UC. Non-medical staff. A civilian among the troops. ... Someone who sits on the guard rail between sickness and health." Just what is this civilian writing about that excited and moved me to the point of volunteering to write this review?
The book evolved from what Steinmetz describes as "practice pieces, finger exercises," written quickly in moments stolen on the job. At first glance it seems an untidy collection of vignettes, anecdotes, snippets, jottings and hasty scribblings. But what emerges is a unique picture of the remarkable sociological phenomenon that is a contemporary teaching hospital. Steinmetz marvelled when he viewed his own large intestine on the monitor during an endoscopy; in this book, he gives an endoscopic view of hospital life. He writes of patients, families, physicians, nurses, orderlies; of operations, deaths, heroic treatments and miserable failures. But mostly he writes about people — physicians not least. A feeling I had throughout was that strange combination of curiosity and pleasure I experience when reading sympathetic articles about Canada in foreign newspapers. Reading this book we become, with Steinmetz, voyeurs, peeking at medicine through his sensitive but never squeamish, admiring but never sycophantic eyes. What a relief from the doctor-bashing and hospital-bashing we are used to.
Steinmetz is not short of amazing stories, such as his account of helping an understandably bemused nurse apply leaches to reduce vascular congestion of a skin flap, or of the use of a pig's liver to salvage a very sick patient waiting for a transplant. "Can they do that?" he asks. Steinmetz ruminates about the ICU medical staff and then concludes with unabashed awe: "They can do anything." I feel the same way when I visit the ICU and see what my technodoc colleagues are doing. But his greatest strength as a writer lies in his quirky observations of people. As in his description of "Veronika, in her early sixties, Romanian, one of the night orderlies. Forty years of hospital service, only minor repairs. Growing old, grown old, wiping bums, folding sheets and bringing water. She wears a white tight blouse, a piece that billows below the waist, tennis style, circa Billy Jean King. Beside her co-workers, a parade of shiny males with greenhouse-grown biceps, Veronika is stringy meat, obsolete." And of "the flamboyant Dr. S, a jolly, efficient, eccentric. Tonight he sports a pair of black, anti-embolic, spandex cycling shorts. He's on his way out. His mountain-bike is chained to a lamppost outside. He's nouveau young." I chuckled again at his depiction of a neurology resident who "waltzes in carrying a small, black leather handbag. He's here to tune the piano. Press keys, check the action, elicit notes, reflexes, involuntary body responses is the game."
Then there is the story of K, a dying man who "arrived on the unit several weeks ago. A symphony of symptoms. ... K is the property of Vascular Surgery. Not much they can do for him." The story of this man's slow death unfolds in delectable and poignant snippets that pop up unexpectedly. K's wife and daughters sing melodious Ukrainian hymns on and off for days by the bedside: "They are burying him with songs, draping words and melodies over him, elemental as fire." Steinmetz listens unabashedly, and is moved — as we are.
More ruminations (certain to meet the approval of this neurologist): "Blood. One of the lower classes of body fluids today, an untouchable, a caste below urine. Spinal fluid remains aristocratic, silver clear, pure as spring water. But blood has taken a beating. Yesterday it wore a cape, blood was valiant, vital, a bright, red metaphor for courage. The quarterback of life. Today blood is just another body fluid, dark, mischievous, heinous, sneaky, and untrustworthy."
Out of the high-tech, brightly lit, protective cocoon of the ICU, Steinmetz is booted into the ER. Things are different there. How well he describes the humiliation patients suffer as a result not only of their own bodies suddenly failing them but of the awfulness of our overcrowded emergency departments in spite of their heroic, exhausted staff. Not to mention the cold fury of the appropriately appalled family members. This is what wrenches my own gut when it's my turn to do neurology consults in the ER. Steinmetz is no fact-producing newspaper hack; he wields his steel-edged scalpel with a delicate, nimble touch, and his political thrusts are the sharper for it. Meanwhile, he quietly agonizes over his own impotence in the midst of this sociomedical carnage. As the reader, I quietly admire the decency of this UC/civilian/writer.
A recurring theme in a book built of recurring themes is Steinmetz's fascination with the medical history. This is hardly surprising in a writer. He is intrigued by the process of history-taking and by how the history is amended and polished as it ascends from the quick and pragmatic first pass in the ER. He is also fascinated by diagnostic processes, as when the cardiology resident "plugs into her stethoscope and lowers her head down over the man's chest. Tick. Tick. Tick. Shush. She's picking his lock, his safety deposit box." This is powerful writing.
This book makes me, as a physician, both proud and ashamed of what I do. Buy it and read it. Give copies to your physician friends. You will laugh, cry and sometimes curse, but you'll be all the better for it.
John Stewart
Montreal Neurological Hospital and
McGill University Hospital Centre Montreal
[Contents]
One thousand words
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[Contents]
Lifeworks
Stepford mothers
Motherhood issues are the subject of a collaborative installation on view at the Art Gallery of Greater Victoria until March 19. In fieldnotes from maternal territory: An Exhibition about Mothering, Vancouver-based artists jil p. weaving and Margaret Naylor probe our expectations of a role that is becoming increasingly politicized by the combined pressures of economics, technology and societal change. The exhibition was first mounted by the Surrey Art Gallery in the winter of 1997-1998.
 | Margaret Naylor, Treehouse (detail). From fieldnotes from maternal territory "There is no basic [mother], no fixed identity, but only a construction in progress." Courtesy Surrey Art Gallery, Surrey, BC |
Naylor's mixed-media sculptural pieces express in narrative and symbolic terms the "apprehension and doubt" that surround the mother's role as "nurturer," "teacher" and "protector." Her hand-built, quasi-architectural models are metaphors for mothering as "a cultural construct, shaped through repetition of language, images and design that carry with them certain ideological positions."
weaving's contribution includes a Web site (accessible at aggv.bc.ca) for the Department of Maternal Affairs, a fictional government agency that regulates reproduction and childrearing. In weaving's dystopian vision, children are conceived in vitro from genetically manipulated gametes and implanted in "mombots," robotic clones of the biological mother. Through a simulated pregnancy, the real mother can enjoy the "maternal thrill of hormonal change" without interrupting her career, while the development of her fetus is monitored through the mombot's transparent womb. The mombot raises the child within parameters approved by the state, managing all domestic and maternal duties with superlative ability and cheerfulness until the child enters school. Then, sensing her redundancy, she returns to the DMA in her state-issued minivan for decommissioning. In the gallery installation, a series of 29 cartoon panels narrates the case of a deviant mombot who disguises herself as a human.
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The satire is extreme, but the dilemma it describes is familiar to many women struggling to position themselves within a shifting field of values and demands. Amid the many constructions of motherhood — ranging from greeting-card sentiment to the medicalization of pregnancy to the appraisal of mothering as "time out" — many a working mother has been reduced to a mombot.
| Clemie Hoshino, mother and piano teacher, with children. From the fieldnotes from maternal territory "room of honour" Courtesy Surrey Art Gallery, Surrey, BC |  |
weaving and Naylor preface the exhibition with quotations from feminist theory, but they also take pains to represent motherhood without a mediating critique. A "room of honour" displays more than 150 photographs, on loan from the general public, of mothers and their children. In inviting these contributions the artists have attempted to reflect the diversity of the community and to counteract their own psychosocial biases. One of the challenges of feminism is to avoid replacing one set of values with an equally repressive alternative. Another is to refute stereotypes while maintaining an entitlement to some of the very attributes — femininity, for example — that stereotypes exaggerate and thus deride. weaving and Naylor's awareness of these challenges prevents this intensely political work from becoming reductively so. Mothers may be social constructs, but that doesn't mean they aren't also real.
Anne Marie Todkill
Editor, The Left Atrium
[Contents]
Empathy
She may have
galactorrhea, etiology unknown —
Today, we sit together
Her face, pitted and scarred
She tells me how it is for her
I listen
shared the virus
unknowingly —
breast milk
expressed on exam
shot upward
into my eye.
eye to eye
physician to patient
roles assigned.
so much cocaine
her eyes deep with despair
her viral load high, so high.
this cocktail —
stomach sickness
bone weariness
no energy
fear.
She weeps.
and wait
and empathize with her,
but I know.
Ruth Elwood Martin
Vancouver, BC
In May 1999, 12 months postexposure, the author tested negative for HIV.
[Contents]
Out of Mexico
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[Contents]
Room for a view
The intern and the farmer
More than 20 years ago I moved back to my home town to take up an internship in a large teaching hospital. Although I had grown up in the community, the medical system and the hospital were strange to me. Tests were ordered differently from the way I'd become used to in my training so far, and the roles of the nurses and residents were somewhat unexpected. I was frightened and anxious. I felt inadequate, as though I weren't up to the task of being a physician, and I was bewildered by all that was happening around me. About three weeks into this turmoil I met Roy, a 71-year-old farmer from a nearby community who'd never been sick a day in his life. Until now. He came to be investigated for jaundice (in those far-off days it was still possible to be admitted for such things) and I was assigned to "work him up." Roy was more confused and frightened than I was, and for good reason. He had no experience at all of illness and not much with the medical system. The jargon made no sense and the implications of his symptoms weren't at all clear to him. My feelings of uncertainty and insecurity were trivial compared to what he was dealing with, yet I felt a kinship with him. I wasn't sure how I could help him, given my limited knowledge and skill. But there was one thing that I knew I could do pretty well: I could talk, and talk we did. I interpreted the results of the tests, all of which were ominous, and the plans of the consultants. He told me about his family and shared his fears and sense of unfairness about what was happening to him. He made me feel like I was helping, and I think I gave him the feeling that he was important. I was no older than his grandchildren, and still uncomfortable with the label of "Doctor," so I enjoyed his nickname for me: Little Pal. I didn't worry about boundaries or professional dignity; I just knew that we both needed the trust and comfort that we provided for one another. On morning rounds with the consultant, the head nurse and various levels of residents and medical students, it was reassuring to hear him greet me. "There's my little pal!" he'd say.
Things didn't work out well for Roy. The tests all indicated that he had metastatic cancer, and the consultant recommended that he stay in hospital for chemotherapy. Roy was hopeful at first, and I felt terrible. Although none of the experts were explicit about it, I realized that he likely had little time left. Was it a betrayal of trust to hope along with him? Would a good doctor be very clear about the prognosis, or would he or she encourage belief in the miracles of science? I didn't know what was right, so I just kept visiting and answering Roy's questions as they came up.
One day the whole team of consultants, residents, nurses and students swept into Roy's room on rounds. Ignoring them all, he looked directly at me.
"Little Pal," he said, "this chemo isn't doing me any good, is it?"
Oh, Lord, what would a good doctor say? What would the oncologist say? But Roy was looking at me, so I answered with my own belief.
"No, it's not," I said.
"That's what I think, too. So I'd like to stop it now. Can I do that?"
I had no experience with patients refusing treatment. What were the rules? Was it up to me to decide?
"Yes, we'll stop it, if that's what you want," I said.
"And I'd like to go home, where my friends and family can visit me more easily. Can I do that?"
I had no idea how to go about arranging a transfer to the small hospital in his community, but I knew that I would make it happen.
"Yes," I answered, but my voice was shaking and tears were pouring down my face.
"Thanks, Little Pal."
Then I left Roy's room, with the team following behind me.
I stood in the corridor of the big teaching hospital and wept. Not for Roy, really, because he was so obviously prepared for what lay ahead and so at peace with his decision. I wept for the inevitability of the death of a good and gentle man, for my own loss, and for the beauty of his grace and acceptance. As I cried I wished desperately to be able to stop, because I had never seen a physician cry about a patient before, and because I felt so unprofessional, so human. The doctor who began telling me about the latest pain control strategies was of no help to me. But the resident who put his arm around me and gave me a squeeze was. So was the one who silently handed me a tissue. It was the first time I shed tears in the course of my professional work, but it certainly wasn't the last.
Roy was transferred to the little hospital, where he died several weeks later. I continued my training as a physician, a role in which I now feel comfortable as I never could have imagined I would. I never think of Roy without a few tears, and never without gratitude. From him I learned that sometimes caring is the most important thing a patient can be given. He showed me that death could come with grace and acceptance, and gave me the confidence that comes from being the person that a patient looks to for help, even when there are more experienced experts on hand.
Thanks, Pal.
Allyn Walsh
Department of Family Medicine
McMaster University
Hamilton, Ont.
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