MOUNT HOPE:

LIFE AND DEATH AT THE HOSPITAL - Pg. 2

But to act that way, you have to feel entitled to attention — and that was not the way Mr. Townshend felt, not when he was otherwise as healthy as a trout, especially not when he read and heard every day how expensive Canadian health care was, how it was abused and overused, how we can’t afford it. So when he arrived at Mount Sinai three days ago, it seemed like another planet. “I’m the kind of guy who, if he had to get up on that roof, he’d think, ‘How can I do that without a ladder? Because it’s so much trouble to get a ladder.’ And that was the worst of the cancer. I couldn’t figure any way out of it. I was trapped. I couldn’t get out of it.”

Now, suddenly, he can get anything he needs, when he needs it. “I see a huge hospital, and people everywhere, and waiting rooms full of people, and I’m here to see the worldfamous doctor. And he says, ‘I want another MRI, I’ll fit you in this afternoon.’ And I’m thinking, how in blazes can you do this? I’m not the only person in Toronto. How can they do it?” They can do it because once you reach Mr. Townshend’s stage of cancer, they can do anything. The question is, do you need to get to that stage? Criticizing big-city medicine is almost a national sport in Canada. But at the high end of the medical ladder, an acutecare hospital such as Mount Sinai is without peer. It was at the other, everyday end of the Canadian medical system, down where most of us live, where Mr. Townshend found it hard to attract any attention.

•     •     •

Seven thousand, two hundred and seventy-two children were born at Mount Sinai last year. An additional 542 patients died. A few more dead arrive at the hospital through the back door — as research cadavers, delivered from the University of Toronto to the hospital’s surgical-skills centre early in the morning, via black Econoline truck, in black plastic bags inside funeral bags. The funeral bags are navy blue with Swiss dots.

Perhaps you assumed the well-tended body you plan to donate to science would go intact, looking good, to all the noblest causes. You would be wrong. Today’s delivery is five female torsos, bottom halves only so Mount Sinai’s surgeons can practise a new bladder-lining technique designed to help women control incontinence. There’s also a bag of temporal bones for an ear, nose and throat doctor. The half-stiffs cost $200 each. By 10 a.m., though, the surgical-skills centre is hopping with live bodies. It’s Day 1 of classes for first-year surgical residents associated with the University of Toronto’s teaching hospitals, of which Mount Sinai is one — brand-new doctors who graduated from medical school in June with brandnew degrees and not much else. A third are women, a radical development in what has always been a male enclave. Zane Cohen, surgeon in chief, is happy to see them. “They take more time with the patient,” he says, “and they have more empathy.”

Residents practise in the skills lab — gall bladder surgery on a pig’s liver, microsurgery on the blood vessels in a turkey thigh. And of course there’s that brown, plastic . . . backside, curved over the edge of that table. It’s the Accutouch Endoscopy Simulator, which can convey the actual feel of steering a camera into someone’s posterior, with heads-up display: You have perforated the patient’s colon. This is a potentially fatal complication. Today, the newbies are being led through gowning and gloving and draping and wrapping. Some are already wearing scrubs, the specially non-linting cotton tops and pants that doctors and nurses wear.

This is the beginning of professional life for these young men and women. They work 85 to 110 hours a week, with every fourth night on call. For this, they make $45,000 a year — thanks to the Professional Association of Interns and Residents in Ontario, their union. Thirty years ago, a cardiology resident made $400 a year and was on call every other night. Even so, on an hourly basis, these new doctors make half of what the cleaners do. By the time the most highly trained ones finish— the cardiologists, the plastic surgeons, the neurosurgeons — they’ll be just shy of 35 years old. (Of course, life then gets instantly better. According to Dr. Cohen, top surgeons at Mount Sinai with a full complement of research, teaching and OR time can slice themselves off about $600,000 a year.)

One thing that gives the newbies trouble is naming and recognizing surgical instruments: Balfour retractors, rib strippers and mosquitoes. Instruction begins with the knife, the famous scalpel — the “slender fish,” Richard Selzer called it — though these days most surgeons use an electric cauterizing pen to do their cutting. (“The pen is less emotional than the knife,” a resident says. “It’s not what it used to be.”) The new residents don’t seem to savour the beautiful names: They’re surgeons, they prefer action. “Surgeons know nothing and do everything,” James Downar, Mount Sinai’s chief medical resident, told me one morning, repeating the standard hospital joke. “Whereas we, the internists, know everything and do nothing.” Surgeons are cavemen, internists are medheads.

But what all doctors want, even the surgeons, what they have competed to claim all their lives in school, is knowledge. Knowledge to a doc is what money is to a broker — the universal commodity. Cagla Eskicioglu — she’s watching the chest draping — became a doctor only last spring, but she’s already convinced she wants to be a colorectal surgeon. She’s in the middle of her colorectal surgery rotation, studying with the much-admired Dr. Cohen. She feels she could cut bowel for the rest of her days.

“There’s just such a range of things to do,” she explains enthusiastically. “There’s really complicated stuff, like colon cancer, on the one hand. And for the days you don’t feel up to it, there’re always hemorrhoids.”

•     •     •

By 2:31 on Wednesday afternoon, four hours and 57 minutes after his surgery began, Don Townshend’s arm is open as wide as a gutted salmon. Dr. Wunder has sawed the tumour away from the humerus, just above the elbow. He has taken the afflicted artery and nerve with it. He has opened a flap in Mr. Townshend’s hip, cut a slice of hip, replaced the flap, stapled it down; and then screwed the hip bone graft in to replace the tumorous humerus.

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