MOUNT HOPE

LIFE AND DEATH AT THE HOSPITAL

A TENDER TERROR - Dec. 3

Two intensive-care units, one hospital: One for beginnings, one for endings. One team of doctors hastens to save a premature baby who waited too long for surgery, unsure what kind of life awaits him. Another eases passages for souls beyond hope. In the final chapter of their series, Ian Brown seeks lessons from his time at Mount Sinai in Toronto, while Kevin Van Paassen keeps his camera’s keen eye open.

Moments of clarity occur in the course of a day in a hospital. They seldom last, but they happen. This afternoon’s turns up when a surgeon asks for a chest retractor for Zachary Bastead. It’s hard to imagine a chest retractor for a baby as small as Zachary. He was born at the end of September at Toronto’s Mount Sinai Hospital nearly four months premature. Now, at the end of October, he still weighs only 900 grams, less than a man’s dress shoe. He still can’t breathe on his own.

In fact, lying on his right side on the operating table, draped and scrubbed and ventilated and anesthetically stilled by a 10th of a cubic centilitre of fentanyl and a smidge of pancuronium (“the drug they give for lethal injection,” according to the anesthesiologist), Zachary looks more like a sewing project than a human being. Ten years ago, Zachary Bastead would have died at birth, when he all but fell out of his mother’s body in the 24th week of her pregnancy. Today, instead, at the Hospital for Sick Children across the street from Mount Sinai, he is having an operation to save his life. It’s still four months before he was supposed to be born.

The surgeons, John Coles and Jamie Bennetts, have to wear custom-made surgical telescopes to be able to see the tiny organs in front of them. The child is so small and their hands are so big, they have to wield forceps like chopsticks to perform the procedure. The anesthetists, meanwhile, are complaining about George Smitherman, Ontario’s Minister of Health. They don’t like him. Mr. Smitherman has declared he will pay financial bonuses to hospitals that perform more hip and knee replacements, more cataract operations, more cancer surgeries — the operations most in demand by adults, the ones with the longest, most politically damaging waiting lists.

But that makes it harder to book operations like this. “Children are not on the priority list,” snaps Helen Holtby, one of the anesthetists. “Not like hip replacements. This baby has waited weeks for surgery.” She considers it Mr. Smitherman’s fault. The doctors knife an incision an inch long into Zachary’s left side. His ribs are thin, the size and translucency of fish bones. The doctors must ligate his patent ductus arteriosus — that is, tie off the blood vessel that bypasses the lungs in fetuses, but which clogs them up once the baby is out of the womb. The way in is through the slit and under Zachary’s lollipop lungs. Where upon Dr. Bennetts asks for the chest retractor.

Now, a chest retractor is often a big whack of a thing. This chest retractor, on the other hand, is the size of a postage stamp. “Do you have a smaller one?” Dr. Bennetts asks. Everyone laughs, as he slips it in between Zachary’s fishy ribs, and screws them open to a gap the size of a quarter. And right there, the moment of clarity occurs, and for an instant the noble dilemma of modern, sprawling hospital medicine is obvious. A big, clever hospital such as Mount Sinai is like a retarded superhero. It can save runty Zachary Bastead as no ordinary mortal could before. But it still doesn’t understand the consequences of the miracles it performs.

Zachary needs a respirator to breathe. The longer he waited for a slot in the operating room to have his ductus snipped, the longer he has to be on the breathing machine. And the longer he’s on the machine, the greater his chances of being mentally impaired, maybe seriously, by the time he’s two years old.

Squirm here, Minister Smitherman.

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