MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL - Pg. 2

“We will experience a pandemic in influenza,” Dr. Low is telling the crowd. “We will not prevent or control a pandemic.” As soon as he says it, he has all their attention.

Dr. Low is a phenomenon – thin, bald, grey, slight, a perpetual- motion microbiologist, Toronto’s own Dr. McGerm. He rose to widespread public prominence during the SARS crisis, when he became the most reassuring face on TV. Ever since, he has been the media’s favourite expert every time there’s a viral outbreak of unknown origin — which happens four or five times a year. In addition to being the chief of microbiology at Mount Sinai, Dr. Low supervises 70 laboratory workers and 18,000 square feet of space, serious acreage in lab land. He’s also medical director of the Ontario government’s public-health laboratories and a professor at the University of Toronto, and has five other clinical, research and teaching posts, and 19 other current appointments. His CV is 132 pages long.

He has not one but two BlackBerrys (one for the hospital, one for government), and a pager, and a cellphone: He has so many cubes and boxes and gadgets hanging from his belt he could be a munitions specialist for the Queen’s Own Rifles. He often starts the day with a television appearance or two, followed by six meetings before lunch, three more meetings and interviews in the afternoon, and a speech about pandemic influenza after dinner. Dr. Low doesn’t like what he imagines when he thinks about avian flu, and he thinks about it every day. So far, roughly half the people who have contracted

“Impact’s gonna depend on two things,” Dr. Low says. “How infectious is it? Is it going to be like SARS, and easily brought under control?” (Easily? That was easy?) “And two, how virulent will it be?”

Then there is oseltamivir, known as Tamiflu in the trade, one of two antiviral agents that can mute or even prevent avian flu, and its attendant ethical problems: “Who do you give Tamiflu to? Is it your first-line medical workers? Politicians? Police? You could argue that the people in the ICU, they shouldn’t get it, because they’re already sick.” This ability to think clearly about terrifying possibilities is why the entire crowd is hanging on Dr. Low’s every word.

“Everyone who works at Mount Sinai during the pandemic will receive Tamiflu as a prophylactic,” he says. But then he adds that “it might be that there is just not enough of the drug available.”

All of a sudden, hands start shooting up like exclamation points. One father wants to know if he should buy a $70 respirator from Home Depot for his asthmatic kids; a woman asks how much she should stockpile. Gradually, a fine, almost invisible mist of concern rises in the auditorium. As Dr. Low says, everyone’s greatest concern at the hospital during SARS was “taking it home to their families. And that’s going to be one of the things in a pandemic.” If you thought the recent rioting in France was bad, wait until there’s not enough Tamiflu to go around in a pandemic.

•     •     •

In a hospital, things can be right and wrong and true and not true at exactly the same time, for exactly the same reasons. Up here on the 18th floor, for instance, next to the intensivecare ward, a place where people go to recover or die but seldom anything in between, Tom Stewart, the director of critical care at Mount Sinai and the University Health Network, is trying to decide whether to prescribe an anti-sepsis drug called Xigris that costs nearly $11,000 for one 96-hour course of treatment — even though the patient, an old man, is likely to die anyway. What should he do? As an administrator, under constant pressure to cut costs and maintain patient flow and free up beds, he should not prescribe the drug. As a humane doctor who has confidence in science, he will. And as a born-again Christian, who believes in God’s will and the power of faith? He’s an interesting man. This is why the hospital is an ongoing argument, a daily debate, a form of incessant intellectual triage: This diagnosis or that one? Spend money here, or there?

Patient Hakan Pirincoglu, top, is given an inner-ear test called an electronystagmography by audiologist Erica Wong (not pictured). Mount Sinai residents, left, practise their diagnostic skills on a sophisticated dummy patient called Sim-Man, which mimics a range of vital signs and symptoms. It even speaks.

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