Details have been fictionalized to protect those involved. It’s been a long and frustrating case, especially for those of us involved in her care. A plot summary follows…

A relatively young (early 60s) lady presents to Ditchwater Emergency with worsening shortness of breath. Her history reveals several interesting tidbits.

She was diagnosed with a particularly aggressive form of lung cancer in 2005, and was placed on two different courses of palliative chemotherapy before her oncologist pulled the plug, in light of her tumor’s continued growth in size. She was hospitalized several weeks prior to this admission with a diagnosis of respiratory failure secondary to end-stage lung disease. She takes reasonably high flows of oxygen at home. She is grossly obese and comes with the panopoly of obesity-related diseases, including reduced mobility, diabetes, and high blood pressure. She was last admitted to Suburban Emergency and had had thoracentesis to drain pleural effusions, and a short course of non-invasive ventilation using the BiPAP machine. She indicated to the internist at Suburban Hospital at the time that she was not interested in therapy beyond non-invasive medication and had no interest in intubation or extensive life-supporting measures. This was documented in his consults written during that time. No other document has come to light indicating her wishes.

Chest x-rays while in Ditchwater show her large tumor in situ but no prominent pneumonia; small pleural effusions and basal lung collapse, but nothing acute. Her shortness of breath continued to worsen with conservative treatment, and she was started on antibiotics for the possibility of early-onset pneumonia. Her condition continued to deteriorate until her level of consciousness deteriorated; a blood gas was done, revealing a CO2 of over 100, indicating hypercapneic ventilatory failure.

Her family had accompanied her on this visit to Ditchwater Emergency, and were quite insistent that she be intubated when her level of consciousness deteriorated. As there was no documentation available to the contrary, and the patient was unable to provide information on her own behalf, the choice was made to intubate her and transport her to Suburban ICU.

Upon arrival to Suburban ICU she was seen by Doctor 1. Doctor 1 did all the necessary investigations and determined that her respiratory failure was not due to any reversible lung process such as a pneumonia. The attempt was made to wake her up and wean her from life support.

When sedation was withdrawn, she failed to regain consciousness. She remained unresponsive to pain and her respirations appeared agonal. A CT scan of her head was done and it showed a massive hemorrhagic stroke, complete with midline shift in the brain, and findings consistent for her cancer having spread to her brain.

Doctor 1 had a conference with the family wherein he outlined the prognosis. She’s full of cancer, she has end-stage lung disease, she is obese and immobile with multiple comorbidities, her oncologist determined her to be palliative in the year 2006 and completely withdrew all treatment in January of 2008. Further medical treatment appeared futile; the progrnosis was grim.

Her family was indignant. They told us that they believe in miracles, and that us ’scientists’ could not be expected to have any faith whatsoever. They told us that they had had multiple family members stand up from disastrous sicknesses and walk out of the intensive care unit, and that she would do the same, if they prayed hard enough.

Dr. 1 determined that they were possibly in denial, and with doctor-changes after the weekend, scheduled another conference, this time with Dr. 2, and the ethics committee. The family reaffirmed their belief that she would stand up and walk out of the intensive care unit, even after a massive stroke had obliterated a good chunk of her brain.

They had spiritual advisors of more than one denomination appear, including a spirit-healer who assessed the patient and told the family with confidence that she did not have cancer. Dr. 2 became very exasperated with the family, and indicated to them that treatment was futile and only prolonged her death. The family responded with threats of litigation.

The doctor who had seen her during her prior admission documented in the patient chart her verbalized wishes to not be “kept alive with machines.” Her family countered with anecdotal accounts of her telling the nurses in Ditchwater that she wants “everything done” and that she is “not dying.” Family threatened staff and doctors with bodily harm; security was posted.

One family member, her mother’s primary caregiver during her cancer treatments, indicated that she agreed with the doctors, but was told by legal advisors that emergency guardianship of her mother would take a prohibitively long period of time, during which the patient would likely die anyway. Other family members indicated to staff that they would be seeking a court injunction preventing the removal of life support (think Terry Schiavo.)

On investigation, it appears that the family’s suddenly strong Christian and non-Christian faith is a new event; a family history reveals a long history of emotional, physical, and sexual abuse. Family remains insistent that she is healing, and that the power of prayer combined with medical care will end with her full recovery.

In the mean time, her condition has deteriorated, with her suffering a major heart attack, with her kidneys failing, and with her lungs requiring a large degree of support to keep her alive. A family conference held a week after her admission to ICU had the family begging for another two weeks of medical support to prove their point. They insisted that a miracle would happen in that time frame. Two weeks later, another family conference was held, with the ethics committee in attendance; the family indicated that they wanted her transferred back to Ditchwater, which has no Intensive Care service to receive her. They were informed that the patient was unlikely to survive the trip, and that the likelihood of finding a physician to accept her was slim. The doctor ended the conference by stating that he was not going to treat any worsening of her condition, whether it be a major cardiac event, a drop in blood pressure, infection, or the like.

Her feet are now black and her toes are rotting off. I don’t know how she’s going to walk out of ICU like that. We keep the door to her ICU room closed and speak to the family as little as possible. All staff have been warned about the threats of physical violence and litigation, and have been told explicitly to limit their exposure to this family as much as possible.

In private and behind locked doors, we refer to her as ‘the undead’ and discuss our deep frustration and sadness at prolonging the pain this woman is experiencing because her family believes that her tumors will disappear and her brain will magically recover and her feet will grow back.

It’s cases like this that mess me up for weeks.

Students write to me in volumes I can only hope to respond to, reporting on their own personal experiences and breakthroughs. These are not people whose use of the Internet has resulted in an “inability to concentrate for long periods of time;” as Jacoby says. I hear from students who have spent hours reading and learning from Wikipedia entries just for the sake of general knowledge. Better still, I hear about collaborative campus parties devoted to making thousands of quality improvements to young articles in one night — or uploading gigabytes of public domain source material.

or: be quiet, you might break something else.

A new layout! Finally, no more kubrick. Tell me if you like it! I like praise.

Money

10 3-credit university courses and one 6-credit course covering the Faculty of Medicine’s prerequisite list: $6,930
18
credits besides, to bring my full complement of credits to 120:
$2,882-$3,546 (depending on whether they are 9, 6, or 3-credit courses)
Fee to write the MCAT exam: $210.00
Application to the Faculty of Medicine: $1,000 per application
Undergraduate MD program: $10,598.48 per year, for a combined total of $42,393.92
Postgraduate
education, minimum 2 years, I’m wanting to take 5: $852.84 per year,
for a combined total of $4,264.20 for five years

Total cost: minimum $58,344.12 in tuition and fees alone, not counting living expenses, books, GST, anything.

Time

Assume 2 years to complete BSc HS: 2
4 years Undergrad medicine: 6
5 years PGME: 11

Age at completion, if I began tomorrow: 35

… Am I motivated enough?

I spent this last weekend in Marmot Basin, on the proving grounds of the Milk Run and other such places, with seven other people hoping for the exact same thing I was.

With me were exactly one snowboarder (jokes about dope go here), an accountant with dreams of being a police officer, a man who skied marmot before they had lifts, two cousins, and a husband-and-wife team. At least I wasn’t the only girl.

The training weekend is less about training and more about proving yourself capable. It improves your skiing, yes, and trains you in how to handle the toboggan in terrain the likes of which you’d never thought possible, but mostly, they want to see what you do if they throw you down a section you don’t know you’re capable of getting down.

Take Headwall, for example. A single black diamond on the map, yes, but full of trees and deep snow, stuck off in a corner somewhere, empties out into the bottom of the Kiefer T-bar, with segments as steep as most double-blacks. I bailed once on that puppy, and what a crash it was. It’s funny how one good yard sale can make you go from ripping it with confidence to tiptoeing your way down.

Interestingly, my biggest problems came when I got scared. Hesitation meant that my toboggan handling was, at times, less handling and more dragging. The trainers kept hammering that concept into me, that I did better when I was more aggressive, that it was when I backed off that I got into trouble.

The trees were my nemesis. On piste, I was great. Off piste was where the hesitation came. Visions of Mark’s lower leg smashing into a zillion pieces danced through my head as I slipped through tight turns with giant spruces on either side of me. In my hesitation I managed to sink ass-deep in a tree well, whack the snowboarder with the handles of my toboggan, and fall more times than I’d care to count. Several of these falls were while handling the toboggan. On the upside, I obeyed the cardinal rule: DON’T LET GO. Not even when the toboggan was practically on top of me, and my skis were above my head.

Epic faceplants aside, it was a super fun weekend. The group was great and we encouraged each other. By the end my skiing had actually improved dramatically, with me remembering such basics as finishing off my turns instead of skidding right through them and wondering why I was picking up speed. The scenery was beautiful, even with the loud bangs of avalanche-triggering explosives.

We hiked over to Tres Hombres, a side of the mountain within the Marmot leasehold but outside the ski area boundary, in order to inspect the avalanche they had caused with the bombs. Spectacular.

Now I have to go back for my orientation weekend, to do the run that the patrol lead insists “IS NOT A HAZING” … knowing full well that I’ll have absolutely no help.

Wish me luck.

These last several (six? seven?) months have been about self-discovery. Introspection. Challenging my assumptions. Trying to see the bigger picture. Opening myself up to possibilities, being vulnerable and precise, gentler and kinder, sterner without being cruel, learning to love differently, be different, to try and grow.

It’s hard, sometimes, the growing. Sometimes it’s like I’m stunted and it takes effort, physical strain, even, to grow and stretch and leaf out. Lately, though, I’ve been feeling more and more like I felt before my brother died, before I had a soul-crushing year of college, before I believed myself incapable of anything worthy. I have begun again to thirst for knowledge, to want to fill my head with ideas and concepts, to want to explore new things and do exciting things.

On my true love leaving to become a Mountie, on death, on life, and on my own rebirth… I’ve shrugged off the shroud of anxiety I had when I began, that I remember so well from ski patrol, from trying to do a primary survey in front of Moko and being paralyzed with anxiety and fear. I’ve grown into an easy-speaking individual who thinks before she acts, who recognizes her failings, who is confident enough to admit when she doesn’t know and then to ask, in order to learn.

It’s been a very slow process. Slowly putting new ideas in my head, learning about places Elsewhere, learning about (and remembering) people, tasks I had put aside before to concentrate wholeheartedly on myself and fixing what’s wrong. I’m far from done, and it’s been a long haul. I’m only now feeling like I’m getting somewhere.

With this new, blossoming bone-deep desire to fill my head with things, has come the renewed desire to go back to school, to finish a BSc, to become a physician and write my own destiny. I’ve started doing things with a look towards the future… even going so far as to acquire books on purpose specifically because I want to have them in the future, to hand to children and to tell them “you must read this, you’ll love it.”

I’ve started thinking about parentage. My own, and my future. How will I prevent myself from making the same mistakes? How do I want children to grow, and how do I want to shape them? I want to instill on them values I hold very dear, such as being blind to sexual orientation, to gender, to race. I want them to value people, to value life as highly as I do, as highly as (who will likely be) their father does.

Are we getting married? The short answer, is yes. The long answer is, we will be when it’s the time to do so. As it stands now, he’s standing on the brink of a long haul of his own, the physically, mentally, and psychologically demanding task of earning his red serge.

I will be separated from him for the better part of a year. I’ve had a good six months to chew on that fact and swallow it. It will be hard for me, but I have some of my closest friends close at hand, and just the right mix of tough love, intelligent advice, pure affection, and comfort to make it work. I know I will miss him more strongly than I’ve ever missed him before, because we have never, ever been separated for this long. I’ve been dating him for six years, we’ve been together through thick and thin. We’ve done what many married couples never manage. He’s held me through some of the most ripping grief I’ll ever feel, and I’ve held him right back.

I’ll miss him, this is true, but it would be selfish of me to ask him to put down something he’s wanted so badly, for so long, because it’ll be difficult for me. I will have lonely nights, and I will cry, and I will reach out for him and he will not be there. But the reason he will not be there is because he’ll be standing up to a far greater challenge, standing up for a job that is-not-a-job, a job he was born to do. Once he graduates, once he wears that uniform that our country is so well-known for, there will be no turning back, no un-doing. He will never not be a Mountie, not ever again.

I know him better than I think anyone else does. I have seen him, and his blue eyes, and his calm smile, and his duckfeathers approach to difficult situations — it rolls off him like water. Shit happens, we move on, we deal, we do what we have to do, we do our best and we must accept that. It’s very matter-of-fact, and it’s refreshing, because so few people are so head-on about life, the universe, and everything.

As much as I know I’ll miss him painfully while he’s gone, I know I’ll look back at this period, the period where he literally gives his life away to the RCMP to change and give back to him, as one of the most fulfilling things we’ve ever done. I say ‘we’ though he’ll be the one doing the hardest work — I say ‘we’ because of the changes I’m sure this will have on our relationship.

I can’t be separate for so long and not, in some way, learn to appreciate him more. Hell, I appreciate him more already — remembering to thank him when he does things, to be gentle when I chastise, to always-always-never be deliberately hurtful, to cry with him, and to be honest, even when that honesty slices me like a hot knife.

I am experiencing pain, and I cannot anaesthetize it. To do so would be to do exactly what I fear doing — to repeat the mistakes my parents make. I must bear this pain and let it change me, and learn to adapt. I must take it and do with it what I did when my brother died.

I haven’t written much about it, mostly for fear of being a complete downer. I’m also afraid if I talk about it, people will think I’m fishing for sympathy, that somehow I want hand-holding and comfort for my whining. I think this stems partly from my own paranoia, and partly from having assholes in my life who told me three days after the fact to quit “acting like such a martyr.” I think the first thing I learned was what makes an important friend, what a friend is, and when to savagely cut that tie without regret and without anxiety over making the wrong decision.

In short, I learned that I have value too, that I am important, and that anybody who believes otherwise has no business being in my life, taking up my precious time, and influencing my decisions.

I learned how truly small I really am, and how much difficult and passionate work it is to be significant. The world didn’t stop because mine did. It kept right on going, and I had the option to keep up, or not.

Since picking up the ball again and moving with it for most of a couple of years, it’s felt more and more natural, and I feel more and more like I should be feeling again. I’ve learned I’ll likely be medicated for mental illness for the better part of the rest of my life, but if one pill a day keeps me from circular, hyperparanoid thoughts, I’m okay with that. I’ve started to feel more and more emotionally ready for more … nevermind what that more means.

I’ve had to think, since Moko will be joining the RCMP and could be posted nearly anywhere in Canada, about my job prospects and how to maintain my portability. My job is only so portable, if I want to experience the kind of subject matter I want to experience. It also strips from me a degree of autonomy — and anybody who knows me knows I want to be the one running the show. I’ve been getting bored where I am, and I’m starting to feel more and more emotionally ready to make the change I’ve been talking about on and off for years.

The prospect of getting that MD after my name, of becoming a physician, likely an Emergency Room physician at this rate, is daunting, since it involves around a decade further worth of education, as well as approximately $100,000 or more in debt. However, that debt means I’ll never want for money ever, ever again, and will always, always have an interesting, meaningful job.

It struck me, today, what those two letters mean. I saw a commercial for Medecins Sans Frontieres (doctors without borders) today, and was struck dumb by the thought that “I could do that.” I have a potential, an unrealized potential, I could be significant, if I chose to be. If I choose to be. If I want to be.

So I think back about the most significant people in my life, and who I surround myself with. One with a master’s, who wants a PhD, who teaches at a university level. One who wants her master’s, one who wants to teach, who wants to enable people, women, one who wants to change his world one person at a time, and so on, and so forth. Forward-minded broad-thinking highly intelligent people, capable of greatness. So am I.

Most people go through their life sifting through choices and trying to make choices that are easier, trying to avoid difficulty. This is a choice I’m making in advance, full well knowing that it’ll be difficult. But I’ve done difficult things, and survived. In fact, I’ve become a better person for them. Why should I shy from a difficult thing, simply because it is difficult? Don’t I chastise my own friends for such defeatist patterns?

Moko is certainly not shying away from Depot, even knowing full well that they will purposely break him down, to build him back up again. He knows that their highest attrition comes not from people deciding it’s too hard, but from people being so physically exhausted from their rigorous physical training that they lack the energy and ability to succeed at the mental training. This will be like boot camp, except worse, far worse. He’s standing up tall, agreeing to move anywhere they tell him to, agreeing to carry a sidearm for his country, and to use it in a deadly fashion should he be required to for the greater good.

It’s a difficult thing, this not being able to ever un-be a police officer. And he’s going to do it because he was born to do it.

As much as it’d be easy to shy away from my own challenge, I can’t choose the easy way simply by virtue of it being easy. That’s not how the right choices are made.

I’m blessed to be in the position I’m in, to be able to do this, and I’d be a fool not to do it.

In this process of self-discovery, I’ve been sharing my insights with some close friends, including a newly close one, who I am proud to count among my most-loved friends, who cherishes me as a good friend should, and I can feel it in his touch. I have so much love around me, and Moko is so deeply trusting to let me explore it — a lesser man would be less perfect in his trust. I am therefore very careful to ensure I never violate it — and I think the arrangement has strengthened our friendship and our relationship. I have no doubts that this is the person for me, so much so, that when someone makes a comment like “Something could happen and you’d no longer be with Moko” I have to shake my head for a second to understand what they’re talking about.

I’m very proud, because I’ve become the kind of person I’ve always hoped I’d be — somebody who’s lived through difficulty, who’s worked her ass off to get what she wants to have, and who doesn’t piss and moan about a problem without having a solution in mind. I’ve grown real strength, and I’m never one to brag, but I’m so proud of this strength I’ve found, so thankful, so grateful. I don’t know where I found it but I want to take it and be a warrior and a hero along with my warrior-hero himself.

There is so much love in the world, and seeking it out and loving it for what it is has turned me into a better person. I want to live the words I speak, and help everyone around me grow as they want to. I love them all, partly because they are like me, and want to grow and love. It’s amazing, it’s life-changing. I can do it. I just need to plan how.

Be the change you want to see in the world.

- Mahatma Gandhi

I’ve taken lately to putting as many slang terms into my daily speech as possible. ‘Whatever’ has become ‘whatevz’, and I use the term ‘om nom nom’ or some variation of it in excess. I think I said something to Molly last night along the lines and it was basically slangslangslangslang normal word slangslangslang. I’m not really sure why I’m doing it, but I feel something like a dj, spinning out hit after hit after hit to make the crowd go wild.

Despite the fact, of course, that people seem downright puzzled by my speech patterns (which alter at my job and I assume a hick accent, much to the dismay of my city-chick side), I still think I talk like a rad wild thing.

In other news, I got in touch with my feminine side since I’m off work for practically a whole month. (Oh thank god, oh thank god.)

Molly and I did a little shopping today, where I bought way too many gifts for my fiancee, a few presents for Molly (hardworking, utterly deserving thing that she is), and not very much for myself. This always happens. When I have money, I like to spend it on other people, for some reason it brings me more joy than just spending it on myself.

I did, though, pick up a new bra and thong set from La Senza. It’s truly fabulous, and makes my rack look like a $30,000 breast job. Ace star. Plus, it doesn’t pinch which does my somewhat chubby-totally-fab-body a relief. Om nom nom, lingerie. Now Molly has painted my nails a lovely deathly black, and I am totally ready to face the world for the, er, 27 hours of travelling I will do starting Friday night.

I can handle it, I’m a big girl. Whatevz.

<3 Apotro

A pager buzz, and I’m upright again, leaping at the phone. The voice on the other end is one I recognize well; after a day of taking pages from Emergency, the unit clerk’s voice is very familiar to me.

“Hello, Cathy speaking, it’s me speaking, from respiratory.”

An attempt at a joke is brushed past casually as she informs me quite seriously that the suburban EMS crew has phoned ahead to let us know they’re bringing us a dead baby. We’re supposed to make him alive again; the crew themselves are a little busy with that right now. My heart drops into my shoes.

I am moving towards Emerg in long strides, as long a stride as I can manage without outright running. Nobody’s here yet, they’re five minutes out; I have no reason to panic, and running makes others panic. I must be calm, the lightning rod of calm in the sea of chaos.

I’m pacing the space of Trauma 2, all curtains thrown open, a stretcher, white, pristine, but not inviting. I’m pulling down my bagger, wondering how old this baby is, if the mask I have currently attached is going to be the right size. The Broselow tape is laid out on the bed, the expensive piece of paper, our lifeline, sandwiched between two pieces of lucite. I scan it quickly, opening the colour-coded intubation bag, pulling out things I anticipate the need for, organizing them as to size. Nurses stand almost at attention, an informal kind of attention, noses in the air, trying to see over the ambulance bay door for red lights flying in, straining ears for sirens that will come before the baby does.

Jeff is my doc, my emerg doc. He’s a lanky cowboy of a man, with an easy smile, a calm demeanor, and a willingness to explain everything in a smooth and relaxed voice. I try and emulate his calmness, try to slow my heart down by thinking hard enough. My job is easy — keep him breathing, or make him breathe, or both, and help where I can.

Medics pull in, doors open, a stretcher pops out. A man I recognize in shiny-stripe pants is at the side, one hand on the kid’s chest. Another is trying to bag with a mask while a firefighter pulls their stretcher towards the doors. My heart sinks — the paramedics didn’t get him intubated. We’ll need an airway first. I try and guess sizes from the trauma bay while I click laryngoscope blades into position, shining the light onto my hand to check for brightness.

Medics tell us breathlessly while we slide the kid onto the stretcher that the babysitter put him down for a nap, came in hours later to find him not breathing with no pulse. The baby is white — his skin, and his colour on the Broselow tape. Jeff puts the laryngoscope blade in his mouth, sweeping tongue aside, while I get a good look at baby’s limp body and notice mottled purple marks along his back and bottom. Jeff’s having trouble — his neck is stiff. My heart pumps cold blood all of a sudden — this baby has been down a long time.

I take over compressions for the medic while Jeff tries to get a tube in. I overhear the medic say that the kid’s airway was so swollen it was impossible to get a tube in — Jeff is having the same problem, likely from all the poking around that happened earlier. Jeff gives up, and I grab the bagger, trading off compressions again. I have good air movement with just a mask — I have enough of an airway to work with, for now, and given the way the kid looks, we won’t be at this for more than 30 minutes. I feel a tightening in my chest, and quickly squash it — I will have time to think about pain after the death certificate is signed.

We don’t even know his name — the medics grabbed him and ran. One is talking to the unit clerk, laptop in hand, and I’m sure she knows his name — I don’t need to know. He doesn’t need a name to breathe.

He has no veins left, all of the blood pooling in his back and other areas gravity leads it to. His face is white, his skin translucent, and he is cold to the touch, with white-blue lips. We need to do everything we can, to try, to say we did everything we can. The ECG shows a flat line in three leads, a line that waves slowly up and down with the rhythmic pumping of my friends’ hand on baby’s chest. We are so far beyond gone, and I know, and it makes me relax. My colleagues are relaxed. We know there’s nothing to lose, because it’s already lost.

Rog, the other doc, is here, and we need to put fluid in this baby, fluid and drugs to try and kick his heart back into a rhythm. We have no line, no veins to get a line, and Rog grabs the blue-handled plastic contraption I know to be an intra-osseous needle. I avert my eyes and try and shut my ears to the crunch-snap of a needle penetrating bone.

Fluid is fired into a port in the IO needle and it immediately begins backing up in baby’s lungs. Pink froth is coming out of his nose and mouth, smearing on my mask, smearing on my gloves. His eyes are closed, and it makes it seem less unnatural somehow. Drugs are pushed and nothing happens. More drugs, more nothing. Jeff’s compressions are half-hearted now, as we near the end of our allotted 30 minutes.

Jeff and Rog say stop, and we all stop. Stop squeezing bags of saline, stop cracking boxes of epinephrine, I take the mask off of baby’s face, the only pink now coming from his own blood, leaking out of his lungs. I stop, put the bagger down, and step back.

It’s done.

I have five minutes until my shift is over. Time for thinking is later. I grab my colour-coded airway bag, grab the equipment that’s still clean, make a mental note of what we used, and stalk back to the department to re-stock. I am numb. The receptionist asks how it went. “Not good,” I say, and disappear into the stock room to grab fresh gear.

Returning the bag to its altar on the back counter, I survey the scene. I deliberately don’t look at the bed, but rather at the floor, where yellow plastic caps and blue plastic crash-cart locks are strewn about with gauze and crumpled up balls of tape. I exit without looking at anyone or anything, as if I’m invisible if I don’t see anything. I know intellectually I have been profoundly changed. I cannot describe how.

Ten minutes later I have given report, changed out of my scrubs, and I’m in the grocery store squeezing avocados. I look around me, and wonder to myself if I’ve ever seen someone else in the grocery store, another shiftwork superhero, whose hands last touched a dead person before their vegetables. It has never occurred to me before, but somehow, I will not be able to shop at this store again without wondering that exact thing.

I still can’t describe how I’m changed, and these changes inspire a kind of reverence in me. It feels like life should stop, now. I’m sure it feels like it’s stopped for that mum, who thank God, I didn’t have to look at. I’m not upset or crying now, but if I had seen her, I’m sure I would be.

I’m going to have to tell someone, before I wake up screaming from nightmares.

I was born. And then there was enough of that.

How to sum it up? Why refuse to discuss it?

I witness it too often, and when I see it, I relive it. Never mind that my exit wasn’t through a split belly, squished out by some surgeon, gurgling with life. Mine was different, and my mother tells me the story often. I came the ‘natural’ way, so they say. I don’t care either way – I’m upright, that’s what matters.

And upright I am, at 3:38 in the a.m., according to the top of the pager I itch on my hip. I’m trying to appear bright-eyed, but the truth is that I was half-asleep when the buzzing woke me up. Not really asleep; a half-sleep, a period of suspended animation between pager-rings.

Upright. Here. It’s all they want me for, this quick job I do for them. This is my job, a summary of quick jobs. Show up, fix it, leave, I joke. I like it, though. It works.

They call me, day or night, I show up. I could be there for 10 minutes, I could be there for three hours. Or, the specialists, the ones who are there 24-7. That’s not me. I like my sleep too much.

This job, this quick job I do, is resuscitate newborn babies. They call me to be their extra hands if they ever think things will get hairy. I show up, I wait for a baby. Sometimes the baby’s a little stunned. I like that turn of phrase; stunned. As if hibernating. And it seems that way, sometimes, when they hand me someone cold, limp and pale and I rub and breathe it back to life.

I make a couple of notes; that I was there (with a signature) on the birth chart, as well as scores given to how fast the baby was resuscitated. Sometimes I glance over everything in advance, to get an idea what I’m up against. Sometimes babies have been exposed to narcotics – then we want to wake them up with antidotes. Sometimes babies have been exposed to narcotics on a chronic basis. Waking those babies up could kill them.

I try to put myself in her shoes. I remember being very young, too young to understand, and being loudly accused of racism. I try to anticipate what will be different. Are men not allowed? Or will her children be in there, watching? Will it be a teenaged boy, or her own mother? A much, much older man?

Sometimes, things go bad, babies must be attended to, specialists must be called in. They come with a very expensive baby carriage, and whisk the peanut away. That’s when I stay the longest. I’m holding on to their lives for them, until someone else can take them from me.

Most of the time, though, babies slip out just fine. I watched one come out with no pushes. She just relaxed. Baby just slid right out, at its own good pace. Some get tangled, some get stuck. Even still, most of the time, untangle or unstuck and they emerge, squirming and breathing.

Breathing being the important thing.

It’s my favourite part. These mini-injections of other peoples’ joy. No strings attached. Rub babies back to life, for money.

The ability to go from out cold asleep, horizontal and wrapped in a blanket to shoes on, glasses on, running down the hall in less than 15 seconds.

That “Respiratory to Emergency STAT” bell is some kind of motivation, even if I wasn’t fully conscious until I had run about halfway there.