MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL - Pg. 3

Everyone has an opinion on what a hospital like Mount Sinai is doing and what it isn’t doing, what it needs to do and what it ought not to do. Sometimes the entire health-care system seems like a swarm of peeves and temper, beneath which a few stubborn souls go about saving lives regardless. There are specialists who operate private clinics who insist Canada can’t afford high-end, publicly funded hospitals such as Mount Sinai. Others say those surgeons are self-serving wannabe Americans. There are private-practice doctors who say Mount Sinai’s an ivory tower that needs to re-gear itself to the clinical needs of the population. There are Mount Sinai researchers, such as Katherine Siminovitch, who counter that “if we’d put money into looking after patients rather than research 100 years ago, patients with polio would still be in iron lungs.”

None of it seems to get Tom Stewart down: ICU doctors are the calmest of all. Up here on the top floor of the hospital, the choices are clearer. The patients in the unit look like they are feeding the swarm of machines attached to them rather than the other way around.

One morning as we leave the ward, Dr. Stewart says, “So. What do you think?”

“It makes me realize how many different things can carry you off.”

“But you know what?” he replies. “It’s all luck.”

Maybe he’s right. Only early in the morning and again late at night, before everyone arrives and after everyone has left (save for the patients and the night nurses and the cleaners and a few stubborn women who refuse to leave the bedsides of ailing children or husbands or mothers) does the hospital let its guard down, and appear for what it actually is — a slim net over a dark river, trying to catch souls being swept from one side to the other.

•     •     •

By the second week of September, Lindsay Bastead, 25, of Hillsburgh, Ont., was warming to the experience of being pregnant. Her first attempt had ended in a miscarriage — but so early on in the pregnancy that “we didn’t have a chance to get happy,” as Will Delill, her partner, put it. Ms. Bastead is blond and shy, a country girl; Mr. Delill is older, 37 and a salesman, and did most of their talking. But in April she discovered she was pregnant again. She was still at work in September — at Respan Products Inc. in Erin, outside Toronto, manufacturing respiratory gear — when she felt something give. Her cervix was dilated three centimetres. The local hospital put her on a stretcher and sent an ambulance careening downtown to the high-risk pregnancy unit at Mount Sinai, whose history of obstetrical care dates from its founding in 1923 as a maternity service for Jewish women. (Last year, the hospital delivered 7,272 babies.)

Above: Staff help patient June Sakis to her walker. She was brought into the emergency unit in late September after collapsing at home.

When Ms. Bastead arrived, a doctor named Greg Ryan took time out from his regular specialty — astonishing invasive fetal procedures, such as inserting bladder and heart shunts into fetuses in utero — to turn her upside down. Then he put a stitch in her cervix to keep her baby inside. It was low-tech, but it seemed to work. Now, it’s two weeks later, and Ms. Bastead has gone into labour anyway. Her cervix is fully dilated, even with the stitch. The baby wants out. Her labour lasts all of 15 minutes. A boy. He doesn’t look much like a 40-week full-term infant. Why would he? The pregnancy has lasted only 24 weeks and five days; the baby wasn’t due for three more months.

But he’s here. His name is Zachary. He weighs 700 grams. He’s a bruiser next to the smallest babies that have survived Mount Sinai’s neonatal intensive-care ward, tiny handfuls that tip in at 465 grams — “four sticks of butter,” as the nurses like to say. But will he live? And if he lives, does he have anywhere close to an even chance of being a normal child? Was it worth saving him?

•     •     •

In a haphazard meeting room on the hospital’s 14th floor, even as Don Low wows and cows the governors four floors above, Mount Sinai’s executive committee on pandemic preparedness — the bird flu gang — has run smack into another brick wall.

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