A Sign of Weakness

I don’t remember what time the next call came. Probably around two. I was back in the workroom, running blearily over the results of the one o’clock draw, fielding pages from the floor. There had been a shift change at midnight, followed by a flurry of pages from the new shift coming on with questions. There was a patient down on 3 West who was refusing his prep for a scheduled colonoscopy.

I heard a knock and an unfamiliar face appeared in the doorway. ‘Are you the doctor on call?’ Shift change. I grunted something affirmative. ‘Do you know the patient in twenty-six?’

An uncomfortable sensation stirred in my chest.

‘I got report on her,’ the new nurse said. ‘Do you still want frequent vital signs?’

‘How’s she doing?’

‘I don’t know. Do you want me to check?’

‘Please,’ I said, and settled my head on my folded arms.

***

A hand shaking my shoulder. ‘Doctor?’

I stirred unpleasantly. My face was stiff. My sleeve was wet.

‘I’m sorry to bother you, but that lady in twenty-six, she’s not looking so good.’

I sat upright.

‘Her O2 sat?’ the nurse went on. ‘It’s only eighty-two. And her rate is over thirty.’

‘Is she wearing her mask?’

‘No.’

‘Christ.’ I was out of the room, stalking down the hall.

She lay in the bed, looking expectantly towards the door, the mask gripped in her hand. Her other hand went up as I approached, waving me away.

‘Mrs B,’ I called to her, pitching my voice as if into the distance.

The head bobbled for a moment, turned my way. The eyebrows were lifted slightly, but the skin above them was unfurrowed. The mouth was a hole air moved through.

‘Mrs B,’ I said again, willing her to look at me.

She did.

‘You have to keep your mask on.’ It did not sound so idiotic when I said it as it does now.

She shook her head.

‘If you don’t do it,’ I said, reaching out to take the mask from her hand, ‘you’re going to die.’ She made an ineffectual motion as I placed the mask over her face, looping the cord behind her head. Her hair was greasy with sweat. She reached up and placed a hand on the mask. My hand and her hand held it there. Did her breathing start to slow? I held the mask through one long minute, another. The nurse was a silhouette at the doorway. Another minute more, and I was sure the rate had fallen, the labouring of her shoulders lessened. To the nurse: ‘Let’s check a sat.’

Ninety-two per cent. To Mrs B, ‘There. That feels better, doesn’t it?’ She nodded, faintly, and seemed to settle into the bed. I let my hand fall away from the mask, crooning, ‘There, there.’ After five minutes pressing the mask to her face, my outstretched arm felt like wood. I reached behind her head to snug the cord.

She pulled the mask away. ‘I can’t breathe. I don’t want it,’ she gasped. ‘It’s too tight.’

And pulled harder until she snapped the cord in two.

I grabbed the mask and held it on her face. She reached up and clutched my wrist, and for a moment I thought we were about to struggle over it, but then she stopped and her hand fell away. Her eyes were fixed on mine.

The nurse was still at the doorway.

‘Ativan,’ I said. ‘Two milligrams IV. And two of morphine.’

Mrs B still stared at me, her face remote and motiveless behind the mask. My arm was aching. Was I pressing the mask too hard? I eased up, fumbled with the broken cord, but the ends were too short to make a new one. Mrs B didn’t take her eyes off mine as the nurse reached for the port in the IV tubing. Just as the nurse’s fingers caught it she snatched her arm away.

‘No.’ The voice was a whisper.

‘I can’t then, Doctor,’ the nurse said.

‘What do you mean?’

‘I can’t force a patient. It would mean my licence.’

‘She’s going to die if she doesn’t keep that mask on.’

‘Then get psychiatry to declare her. But until then it’s her decision. We can’t make it for her.’

Psych wasn’t going to declare her. I knew that. It was her decision. I knew that. But I couldn’t let it end this way. Surely I could make her see.

‘Mrs B,’ I said finally, ‘is there any way we can make this easier for you?’

‘How about a bucket?’ said the nurse.

My expression must have required explanation.

‘A face tent, they call them. It’s open at the top. It works for claustrophobia. Do you want me to call respiratory?’

‘Please.’

***

The respiratory tech arrived after an interminable period during which Mrs B refused again and again to wear the mask. Eventually we found a compromise. She would hold it a few inches below her chin. It bumped the pulse-ox to eighty-eight per cent. But her respiratory rate continued to climb. I couldn’t tell if it was anxiety or hypoxia. A blood gas would have told me, but I was reluctant to try. I didn’t know what I would do with the information. When the tech arrived and fitted her with the bucket, I stood at the door watching. It seemed to be doing something.