“Car versus telephone pole. They’re ten minutes out. CPR in progress. They might bypass us if they can get a helicopter, but for now we’re it…”

***

I am slowed down. I stare at the chalkboard coffee menu, struggling. The barista taps a glossy fingernail on the counter next to the four-dollar biscotti. I shift from foot to foot. Joni Mitchell wafts in the background. She sings of love from a simpler, more complicated time.

I gently rock the stroller with one hand. Inside, my infant daughter is unsettled. She is three months old. It’s not clear yet what she has planned. Will she drift back into peaceful sleep, or break like a rack of pool balls into angry protest? And so I engage in the age-old parental subterfuge of gentle rocking. Maybe she is hot, or cold, or hungry, or wet, or tired. But for now, she is soothed. If only it was that easy for me.

In slow motion, a middle-aged man cuts in front of us. He is talking to someone on his cellphone. His conversation doesn’t miss a beat. He peers over his tortoiseshell glasses and spurts out his staccato coffee order. I feel a wave of anger wash over me. I let it settle and drain away. I walk through life these days in a cloud of fatigue, and my baser instincts can bubble to the surface if I am not careful. I have been up twice since three a.m. I am bleary-eyed and irritable.

The barista announces a grande cappuccino. I collect the coffee, and chide myself quietly for adding a plastic lid. We head for the park. Mostly because new parents are supposed to take their babies to the park. The baby is bundled in her tiny parka, and the stroller bumps along over hard-packed snow.

I will admit it’s peaceful here. Through her eyes I find new pleasure in the way the mid-morning light sprinkles through the canopy of bare tree branches. I watch a homeless man drift among the garbage bins, collecting bottles. He casts an uninterested glance in our direction. I feel obliged to track his movements with a new wariness. New babies lighten some feelings, and harden others.

Then we are alone, and I watch her sleep. Unexpectedly, she is so active when she sleeps. It reminds me of a summer countryside scene. You expect quiet and still, but you find yourself in the midst of a cacophony of crickets and birds and wind and gurgling water. Her peaceful slumber is made up of fluttering eyelids and soft whimpers and pulsing chest.

We sit quietly together in the park.

***

I am sped up. I stare at the computer screen mounted above our heads in the emergency room hallway. Each line of digital text represents a new patient logged in to be seen. There are dozens. A nurse thrusts a chart into my hand for signature. I find a pen in the front pocket of my green scrubs, which have been through the hospital laundry so many times they feel like cardboard against my skin. I push aside the head of the stethoscope draped around my shoulders, my talisman imbued with all my mystical medical power. The rubber tubing chafes at the back of my neck.

Emergency rooms all over the country are windowless, like bunkers under siege. The waiting room is full to bursting. Outside, a gauntlet of snow and wind wreaks havoc on the cars in the parking lot. There are frosted eyebrows and moustaches. The hallway floor is a minefield of little puddles of brown slush.

There is a steady background drone of rapid conversation, alarms beeping, pneumatic tubes hissing, automatic doors swishing open and closed. We are obliged to speak a little louder to be heard, and with purpose. Every so often the ambulance radio beeps and crackles, heralding another incoming load. It is getting toward eight p.m.

I am making little deals with myself. I will see two more patients, and then I will go to the bathroom. I will see three more, and then I will eat half a sandwich. In my head, the constant whir of mental math dividing up the remaining time. There are four hours left in my shift. I can push hard for three more hours, and then focus on some easy cases. I’ve called the cardiologist twice, if I call again it better be good.

I enter an examination room where a young woman lies on a stretcher, uncomfortable. I have been trained to communicate effectively and empathetically. I know I should sit and open my posture. Make eye contact. Give her my full attention. But I feel the weight of the bunker atmosphere pressing down on me. The invading army up against the gates. So I stand, half-swiveled toward the door. I scribble my notes with head down as we talk. I think about three other things while I hear her story. I am made of clean, modern, unforgiving steel. I am aware, somewhere in the recesses of my mind, that  principles of kindness and care guide what I do. But I am in a volume business. People are puzzles for me to solve and move past.

The head nurse pokes his head into the room. “Car versus telephone pole. They’re ten minutes out. CPR in progress. They might bypass us if they can get a helicopter, but for now we’re it…”

A small band of nurses gathers loosely around me in the trauma bay. Some are young, sharp and confident. A few are older, seasoned, and apprehensive. They are looking to me for direction. The patient will arrive at any moment. My scrubs are ill-fitting, and the stethoscope seems to be growing heavier around my neck. I start to feel like a kid wearing his father’s Sunday suit. We take stock of the equipment, turn on the machines, position ourselves around the room. I step to the edge of the diving board.

***

The afternoon hours at home seem to stretch. The baby is having a difficult day. She fusses, and bottles are given, and diapers are changed, but today there is an existential angst that I don’t know how to soothe. For now, we have retreated to our corners for fitful naps.

Later I bounce her and we walk slow circles around the house. We take careful inventory of the accumulations of life. Wedding photos, struggling houseplants. I think of the way the pictures and ornaments in my parents’ and grandparents’ homes are seared into my memory. I wonder which objects of ours will take on significance for her.

I worry that our home is too adult for a baby. I remember my childhood of rustic farmhouse esthetic, surrounded by warm rich wood and storybook colors; fire engine red and forest green. Our new suburban townhouse is adorned with pastel and glass. Sleek gunmetal-gray furniture. Is it the right palette for a baby? Then again, my child is a modern child of the twenty-first century. Her world will stand on the shoulders of my world, complex and accented and nuanced, the way a flower blooms around a stem.

***

The room is full and noisy. The floor is strewn with heart tracing strips and the plastic tops of opened syringes. A hefty, middle-aged paramedic is doing chest compressions, his face a mask of quiet intensity behind large metal-framed glasses. I maneuver around him to the right side of the gurney, where I have used my handheld ultrasound probe to find blood collecting in the patient’s chest. The kid looks to be about seventeen. He is not breathing, and his skin is ashen. He looks bizarrely serene in the face of such violence. I prepare to place a chest tube between the ribs on the right side, to relieve the pressure and hopefully jumpstart his breathing.

In the university hospitals I was taught to stand at the foot of the bed and command the room with my hands tucked under my arms to keep from getting pulled into a procedure. My job is to keep a wide-angle lens on the scene while others delve into the minutiae of managing the airway, placing tubes and intravenous lines, administering medication. But, as in little emergency rooms across the country tonight, I am the only doctor. I must be actor and director. As I ready myself to make the incision, I field questions from a nurse behind me about medication doses, I watch the up-and-down thrust of chest compressions for efficacy, my eye roves to the wall-mounted heart monitor and back. While I work, I spare a thought for the elderly man with chest pain in the next room, and the woman miscarrying down the hall. I am feeling uncomfortably warm.

I can count on one hand the number of chest tubes I’ve done in my short career, although I’ve played through the algorithm in my head a thousand times. I am conscious of the tremor in my hand and the pulsing in my ears, and I do my best to take slow, steadying breaths. I am wrapped in gown and surgical mask, and everything smells of freshly opened disposable plastic. The hair on the back of my hands has grown matted from the sheen of sweat beneath my nitrile gloves. Later, my hands will be caked in powdery residue. I make my incision through the skin, tentative at first and then bolder, and wriggle the tube into place. I beckon a nurse into my position to take over, and spin away so that the splatter on my gown doesn’t rub on anyone. In my peripheral vision I see the first units of blood hoisted onto metal poles for transfusion. I see the x-ray technician hovering by the door, and I hold up a hand to ask for patience.

The trauma surgeon from the city is on speakerphone, sounding crisp and keen. I catalogue for her what we’ve done so far, where the injuries are, how much blood we have to give. We are a long way from winning, but from out of the initial chaos a plan is crystalizing. There is a long silence in the room while I guide another plastic tube into the patient’s throat so we can connect the ventilator. It takes me two tries, three tries. I feel all eyes on me. I am not particularly good at this, but I get the tube in, and we move on. We do what we have to do, and we move on.

His heart is beating weakly, his future is wildly uncertain, but he is stable enough to transport out. I peel off my gloves and gown, and allow myself a pause in the hallway. There can be no empty moments, so I lean on a supply cart and scribble notes in the patient chart while I take stock. I can’t shake the feeling I’ve somehow gotten away with something. There are nods and half-smiles from the nurses, whose professionalism and calm have helped carry me through. If nothing else, we are feeling a little better about working with each other today.

The trauma case has put me an hour behind schedule. The department has ground to a halt. Adrenaline fades. I feel the ache of muscles in my neck and shoulders, which until now had been gripped with tension. It is time to find a lower gear, to catch up as best I can before sign-out. Then I will eat half a sandwich.

***

I am sped up. It’s a chilly, gusty evening. A time when the air and the light are heavy and serious. I pull into the hospital parking lot for the night shift. I feel tired, but in a familiar functional way, in an abstract way. My phone buzzes as I detour into the lobby coffee shop. The head nurse is calling me. She is telling me about an ambulance case coming in, letting me know we are short-staffed. I realize too late that I’ve cut in line for coffee. I nod an apology at grumpy faces behind me. I finish the phone call, and my daughter’s smiling face peers back at me from the phone’s screen.

Rory O’Sullivan is a family doctor based in Toronto, Canada. He has a lifelong passion for creative writing and narrative. His written work has been published in Intima: A Journal of Narrative Medicine, Pulse: Voices from the Heart of Medicine, and Canadian Family Physician. He is a past recipient of the CFPC Mimi Divinsky Award for narrative in family medicine, and a previous longlist finalist for the International Amy MacRae Award for memoir.