MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL

Above: Surgeons remove the tumour that has grown around his left elbow, arteries and nerves over the past decade. Below: Don Townshend’s wife, Dianne, embraces him before the operation.

“The tumour’s relatively small,” Dr. Wunder says — the previous week, he took one the size of a basketball out of a man’s leg — “but it’s in the worst possible position, around the nerve and the vein.”

He’ll let you touch it: It feels like concrete upholstered in skin, soft and hard at once. Today, he is going to cut it out, preferably without having to amputate Mr. Townshend’s arm. But once the three residents pull draping sheets around Don Townshend’s body, he becomes less human. All that’s visible of the man, poking out of the blue hill, is his arm and his two legs, orangey red with antiseptic and taped off tight where they join his body. They look like spare limbs someone forgot to take home. The human being has become the task. This is how surgeons like Dr. Wunder can do their jobs.

•     •     •

A month after his premature birth at 24 weeks and five days gestation, Zachary Bastead weighs 920 grams, a big gain from his initial 700. Parked on their backs and stomachs in their glass incubators, the mechanical mamas that keep them alive, immobilized between rolled-up flannelette blankets, the preemies look like fancy desserts under glass. Zachary’s not thriving. He is still on an oscillating ventilator (700 breaths a minute), has suffered a mild brain hemorrhage and had one transfusion, 10 per cent of his blood volume. But then, a baby his size has only 63 millilitres of blood, about one-80th the blood supply of an adult male.

In a conference room off one end of the ward, Karel O’Brien, a senior neonatologist in the intensive-care department, is bringing Will Delill and Lindsay Bastead, Zachary’s parents, up to date. Zachary — tiny Zach — needs an operation. Someone needs to open his chest through an incision in his side, slip though his pipsqueak ribs, dart under his thumb-sized lungs, and tie off an extra blood vessel between his aorta and his pulmonary artery. The child seems barely big enough to hold, much less operate on.

“He’s still quite sick,” Dr. O’Brien says in her eight-ounce Irish accent. This is the word Mount Sinai’s doctors use, talking to laypeople — not ill, not some technical explanation, just sick. “He’s being kept alive by a respirator, but the respirator also endangers the lungs.”

“That’s the first time we’ve heard all that,” Mr. Delill says when she’s gone.

•     •     •

Eleven-thirty at night on 12 south: Mostly geriatric patients up here, plus four orthopedic recovery beds. Last weekend, three patients died on this unit. A tiny birdlike woman under a thin blanket launches straight at the nurse when she enters on rounds. “You speak Hungarian!”

“Nah,” Kawah says. There is no way Kawah would speak Hungarian. Kawah, the nurse, is Liberian, a west African with an accent like a gorgeous carved ebony banister.
“But you speak English.”

When Kawah touches her shoulder, the old woman pulls away, flapping her arms. “How ah you?” Kawah says.

“How am I?”
“How ah you?”
“I don’t know,” the old lady answers.

Sometimes there are four to a room. The nurses turn out the lights and tell them to go to sleep, but the old birds yak through the night, watching the lights blink on and off on the buildings downtown, not unlike their memories. Why sleep? There will be plenty of that soon enough.

•     •     •

Don Townshend complained about the pain in his right elbow for 10 years. His family doctor in Charlottetown, where he is an auto mechanic, always said the same thing: “It’s tendinitis.” Whereupon the doctor would give him some medication. “And as long as I took it, I’d have no pain. But I’m not much for taking pills. So I’d take them for as long as the prescription lasted, and then I’d just put up with the pain.” The pain stuck around. A year ago this past June, he noticed his middle finger was going numb. Then his thumb and second finger got harder to close.

Is this beginning to sound like a bad dream you have? By the end of September, Mr. Townshend was at the doctor’s again. He had begun to notice something — “a bit of a thing there, a bit of a buildup.” The lump got the doctor’s attention. It took a few weeks to get in to see an orthopedic surgeon, a few more weeks to get an MRI, a few more still to get a better one. By now it was nearly Christmas. Some Christmas. In the spring, an oncologist finally performed a biopsy. You’ll never guess: It was cancer. An epithelioid hemangioendothelioma, a rare soft-tissue sarcoma. “The worst of it is,” the cancer doctor told him, “it can spread to your lungs and your bones.”

No one would say Mr. Townshend is an angry man. Still, it upset him a little, the way the medical system missed his tumour for 10 years until it was so bad his whole arm was endangered. His wife, Dianne, a former nurse, always said that “everybody should take responsibility for their own health, and pressure the system if it doesn’t feel right.”

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