What others are saying about
Lifeliner: The Judy Taylor Story
“Jeejeebhoy’s style of writing sets the right pace as we follow Judy’s medical difficulties…. It is truly a fascinating and eye-opening story which was well written…. What I found especially entertaining was the nicknames Judy came up with for her devoted doctor — Dr. Cowboy and Dr. JeeJee which she later shortened to Dr. Jeej. A very ill woman indeed but her sense of humor shines out throughout her ordeal…. If you want a book you can’t put down, get Lifeliner into your hands, you’re in for a wild ride with one awesome woman and the genius of a devoted doctor.”
Gloria Oren, Writer and Editor, gives Lifeliner 5 stars on Amazon.com
“A compelling story….Reading it will make you laugh, smile, cringe, cry and most importantly, think. If you want inspiration, Lifeliner has no shortage packed into its pages.”
Diana Rohini LaVigne, Online Editor, Indian Life & Style Magazine and India-West, the South Asian Journalists Association Bay Area Chapter Coordinator, from 4-star Review on Bookideas.com and Amazon.com
“It was through the pioneering work of doctors and researchers such as Dr Jeejeebhoy and the undertaking of the endeavour to actually save this young woman from death that inspired other clinicians and health care providers to further develop the important field of clinical nutrition….While this reading [the book Lifeliner] is highly recommended as an inspiration, today it may be equally important that each and every one of us involved in caring for our fellow men and women to make that little extra effort and remind ourselves to make feeding the ones under our care the highlight of the day that it must remain.”
Olle Ljungqvist, MD, PhD and Claude Pichard, MD, PhD, Head, Clinical Nutrition, Geneva University Hospital from Editorial, “Inspired by the pioneers: The lesson of the Judy Taylor story” Clinical Nutrition (2008) 27, 319-320
“Shireen Jeejeebhoy has written an extraordinary account of Judy Taylor and her fight for life starting in the 1970’s when medical science was not as it is today….Ms. Jeejeebhoy’s ability to write on such a tough subject amazed me, she was able to show compassion for the patient and family while at the same time provide credit to all the medical personnel that went above and beyond to help this patient.”
Carol Hoyer, Ph.D. Family Psychology, from 4-star Amazon.com Review
~~~*~~~~*~~~*~~~
LIFELINER
THE JUDY TAYLOR STORY
by Shireen Anne Jeejeebhoy
To
Dreamers broken, who
Remember
Rise
Try again.
~~~*~~~~*~~~*~~~
Smashwords Edition
Copyright © 2010 by Shireen Anne Jeejeebhoy
This book is also available in print through booksellers or online retailers like Amazon.
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
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~~~*~~~~*~~~*~~~
Contents
Chapter 3 — Surgeries and Starvation
Chapter 5 — Garbage-Bag Dressings
Chapter 7 — “I Could Be Pushing Up Daisies”
Chapter 8 — Judy’s Inspiration
Chapter 11 — Tests and More Tests
Chapter 13 — Going Home with Lester
Chapter 14 — A Different Kind of Dinnertime
Chapter 18 — The Bliss of Life
Chapter 19 — JJ, the Guinea Pig
Chapter 20 — Chromium Deficiency and the Swedish Professor
Chapter 21 — At the Police Station
Chapter 22 — More Family Trouble
Chapter 23 — Death Creeps Close
Chapter 25 — Breaking Bones, Falling Hair
Chapter 26 — LifelineLetter Award
Chapter 27 — Dr. Cowboy, Where Are You?
Chapter 29 — The Battle Is Done
~~~*~~~~*~~~*~~~
by Professor Arvid Wretlind (1919–2002)
Total parenteral nutrition (TPN) has been available for only thirty-odd years. The successful development of this therapy, in a modern sense, was initiated in the late 1930s. However, history in this field goes back more than 350 years.
The first landmark was the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides, and amino acids. The observation in the late 1930s by Robert Elman that amino acids in the form of protein hydrolysate could be administered safely in man was the first major step toward TPN. During the following years, major efforts were made to find methods to prepare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made from the 1920s until the end of the 1950s. However, all of these emulsions caused severe adverse reactions in man.
The first safe fat emulsion, Intralipid, was made available in the early 1960s. This was the second major step toward TPN. It was then no problem to include vitamins, electrolytes, and trace elements in the fat emulsions and in the solutions of amino acids and glucose. A few years later, Stanley Dudrick showed that a central venous catheter could be used to administer the infusion fluid intravenously.
Many clinical investigations and reports have shown that the newly developed intravenous nutritional regimens are adequate alternatives to the ordinary diet. In this way, it has been possible to maintain or obtain a good nutritional condition in most situations when oral or tube feeding cannot be used. TPN has been shown to be of very great clinical importance to prevent and treat starvation often related to high morbidity and mortality. The best answers to questions concerning the adequacy of our total intravenous regimen have been given in reports on patients with the no-bowel syndrome, patients who had been on total intravenous nutrition and had no oral food intake for several years.
The classic case concerns a woman who was treated and investigated by Dr. Khursheed N. Jeejeebhoy and co-workers. The patient, Mrs. Judy Taylor, was operated on in September 1970 at the age of thirty-four. A laparotomy disclosed necrosis of the small and large intestines caused by mesenteric vein thrombosis. All necrotic intestinal tissue had to be removed, and the patient was left with merely the stomach and part of the descending colon. Thus, the patient was unable to resume oral feeding. For this reason, she was given a complete intravenous nutrition, first in the hospital and later in her home. She remained in good health until March 1991, when she succumbed to an infection unrelated to her TPN.
There are many patients with similar histories that have been treated with total intravenous nutrition for several years. This case treated by Dr. Khursheed Jeejeebhoy was the first showing this therapeutic possibility of complete intravenous nutrition.
I have written many different articles and papers and given a large number of lectures on parenteral or intravenous nutrition. In all of these, I have mentioned the names of Dr. Khursheed Jeejeebhoy and Mrs. Judy Taylor several times. Dr. Khursheed Jeejeebhoy has shown that complete long-term intravenous nutrition is of great clinical value to maintain a patient in normal condition in a situation when the patient is unable to use the gastrointestinal tract. Dr. Khursheed Jeejeebhoy must thus be called “the father of complete long-term parenteral nutrition in man.”
I am very glad that this book about Dr. Khursheed Jeejeebhoy and his patient Mrs. Judy Taylor will be published. In this way, the classic studies will be made easily available to coming generations.
~~~*~~~~*~~~*~~~
I first met Judy Taylor as a child, when she invited my father—her gastroenterologist—and his family to her home for a barbecue. I will never forget Judy’s delicious cookies, an unusual treat for me at the time, or the grin on my father’s face as he helped Cliff Taylor, Judy’s husband, grill the hamburgers while chatting with his patients. Still, it was not until I was talking to my former boss, Patti Bregman, at Judy’s memorial that I became inspired to write Judy’s story. I immediately got started on it. However, because of a couple of rather large hiccups, this book took a long time to finish. Each phase of researching and writing brought into my life groups and individuals who helped, encouraged, and supported me. After sixteen years of working on Lifeliner, the list of those who assisted me in getting to know Judy and her medical ups and downs is quite extensive, and I am deeply indebted to them all.
But Lifeliner would never have gotten off the ground without the help of Judy’s family—her husband, Cliff, and her daughters, Cyndy, Julie, and Miriam—my mum and dad, Olive and Khursheed (Jeej) Jeejeebhoy, and my former husband, Normand Landry. Cliff spoke to me for many, many hours about Judy and his life with her; Cyndy was invaluable in helping me to transcribe Judy’s huge stacks of medical records at Toronto General Hospital; Dad spent hours telling me about Judy and total parenteral nutrition and explaining all the technical aspects; Julie showed me a different perspective on Judy; and Miriam spent much time and effort not only answering my questions, but also putting me in contact with others who were able to help me.
The now-defunct CPENA (Canadian Parenteral and Enteral Nutrition Association), led by Judy’s friend and fellow lifeliner Sandra Lapenny at the time I spoke to Judy’s fellow lifeliners about the book, provided the financial support to get me on my way, and its members spent many hours answering my long list of questions. In fact, so many of Judy’s friends, fellow patients, and neighbours—and even those who knew her from far-flung places, like her Swedish friends Britt Lindqvist and Ingalill Bergqvist—wanted to tell me about her that I finally had to call a halt, otherwise I might still be interviewing today. To everyone who gave of their time to answer my questions, I thank you so much. (See the back pages for a complete list of people I interviewed and spoke to about Judy.)
The people at the Oley Foundation in New York, in particular Roslyn Dahl, provided me with valuable assistance and leads over the years, and I’m deeply appreciative of all that they did for me.
As I finally saw the end of the research phase, and just before the second hiccup, my former husband and his colleagues held a fundraiser so that I could complete the research, pay for the hundreds of hours of interview transcribing, and begin writing. I was touched and honoured that so many turned out in order to support me financially. To them, I am truly grateful.
The second hiccup, a closed head injury, led me to have to restart the writing of Lifeliner. At first, I didn’t succeed. After many years of trying and failing, I didn’t think it would be possible anymore. But Miriam introduced me to her generous-hearted friend Ian Connerty early in 2006, and he and my structural editor, Greg Ioannou, got me back on track. They made the completion of my manuscript possible. I cannot thank them both enough.
~~~*~~~~*~~~*~~~
Back in One Hour
“I’m so lucky to have a family, adopted or not! I’m so lucky to be alive!” Judy Ellis Taylor tells her three school-age girls out of the blue on this chilly September morning. They roll their eyes, having heard this before many a time.
Judy didn’t know her biological parents, a twenty-three-year-old nursing-student mother and a twenty-seven-year-old painter father, nor did she care to. To Judy, her real parents were Marjorie and Percy Russell. Shortly after her birth on March 26, 1936, they had scooped up the little round-cheeked, black-haired baby and taken her home. At first, Marjorie hadn’t wanted to adopt this baby. Only six months had passed since their second adopted child had died suddenly; but Percy talked to Marjorie gently and persistently until he convinced his devastated wife that she could adopt again, that she could have her dream of children, children who would live. She acquiesced, and they adopted Judy from a Presbyterian home. To help ensure that both their girls, Joyce and Judy, their first and third adopted children, would have the best chance, they moved from Rosedale to a large house in the valley of York Mills, where violets flowed up to the door in springtime. It meant a one-hour drive to his engineering job, but Percy made it sweeter by bringing home chocolate éclairs. Meanwhile, Marjorie anchored their family life with big weekly Sunday lunches after church.
It was a good decision, for Judy thrived on life. She attended the prestigious Bishop Strachan School during her junior-high years and joined the young people’s group at St. John’s Anglican Church. At thirteen years old, this healthy, mischievous girl pledged herself to Christ at Camp Gay Venture in Haliburton—she didn’t explain why to anyone, just did it—and became a camp counsellor at the same time. Like a mother bird, Judy took charge of the little girls at the camp, including Sandra, a small seven-year-old. Judy especially loved teaching the little ones to ride. But being Judy’s pupil was not an easy thing: she had a tendency to kick her charges out of the nest if she felt that they could handle it, plus she had a penchant for practical jokes.
One sunny day as the group cantered together, Sandra’s black horse (known as Blacky) threw her off. Sandra sniffled on the ground, feeling sorry for herself, while the others milled around. They expected Judy to pick her up, dust her off, and plop her back on her horse. Instead, she steered her horse over and, looking down from her great height, demanded, “Well? What are you going to do about it? I’m going back to the barn. You can either walk or get on your horse and follow me.” She gestured to the others to follow her and rode off.
Sandra howled. Some of the kids looked back, but not one slowed down. They disappeared toward the barn. Sandra stopped, mouth open. No point howling anymore. She closed her mouth. She stood up, climbed onto Blacky, and trotted back to camp, where Judy was waiting. “Well, if you hadn’t done that, you probably wouldn’t ever have ridden again,” Judy informed the little girl. “Now take Blacky in and groom her.”
That fall, Percy decided that Judy would be better off at his (and my) alma mater, Jarvis Collegiate Institute, near the heart of Toronto, and had her transferred there. She did reasonably well. By age seventeen, she knew what she wanted out of life: to find a husband and have a family.
Judy joined her girlfriends at the church picnic near Fenelon Falls that summer, hoping to find a husband. She did. Her friend introduced her to her boyfriend’s buddy. Cliff Taylor was a taciturn, slightly older fellow with a sudden smile and a shock of dark hair. He had to grow up quickly after his mother had tried to kill him along with herself, leaving him alone with his alcoholic father while his younger sister was shipped off to boarding school. By age sixteen, he had dropped out of school to work. He developed a philosophy of paying his own way with cash only. He didn’t believe in credit cards or debt, except for a mortgage perhaps. Unlike Judy, he didn’t live in the genteel areas of town, but he had become successful in sales and was doing well monetarily. Still, the educated, well-off Judy clicked with this man from the wrong side of the tracks. He loved her with a devotion that drove him to cross the threshold of a church, a feat he vowed never to repeat after their marriage on July 27, 1957, in St. John’s Anglican, and she loved him with a strength he could count on.
Cliff bought a new house for his bride, and they settled comfortably into Scar-borough life, spending weekends up at the cottage near his father’s place in Bobcaygeon, Cliff paying for everything in cash, as usual, and Judy looking after their growing brood: Cyndy, Julie, and Miriam. Judy had grasped her dream. With her family complete, she went on the birth control pill, a fairly new drug back in late 1966. She was wildly happy and having fun.
But God wasn’t impressed with Judy’s life plan. He gave her the gifts of toughness, generosity, kindness, healing, advocacy, and teaching. Her dream was too mundane for those gifts, and He would call her to travel to unfamiliar places, places so dark, frightening, and unexpected that she would have no choice but to trust in His faithfulness to her.
Stomach pain was the first intimation of the change to come. The stomach pain was so bad that, after three months, it forced her to see her general practitioner (GP) in February 1967. Despite X-rays, blood tests, and referrals to specialists, nothing revealed the source of her pain, although by 1970 her insatiable appetite and loss of weight clued one of her specialists, a gastroenterologist, into the fact that she might have hyperthyroidism. She joked to her girls that she could run up and down the road at ninety miles an hour, making them laugh while she hid from them the wrenching pain deep inside her. By the summer of 1970, her endocrinologist irradiated her thyroid. Perhaps things would settle down now, Judy and Cliff hoped.
But the pain squeezed harder. Her doctor prescribed morphine; Cliff and Judy hid that, too, from their girls, or so they thought. Family conversations took a strange turn. The talkative, joking Judy suddenly would stop mid-sentence; they would all pretend she hadn’t and would gamely continue on the conversation without her. Suddenly, she’d pop back up and finish her sentence. Unfortunately, she would soon space out again, and cries of “Mom? Mom!” from her girls would go unheeded. Frightened, the three dared not ask about this phenomenon when she resurfaced from wherever she’d been, and they pretended that everything was normal. Judy had deceived herself into thinking they hadn’t noticed, clenching her teeth against the truth, fighting both the pain and the effects of the morphine.
Wednesday, September 23, 1970, dawns cold. The pain had increased during the past weekend. She had spent the time at the cottage, lying balled up on her bed while the children played with their dog, Goldie, under the sunny fall skies. Back at home, she had pushed herself to get through Monday and Tuesday, but today, Wednesday, she calls her GP. With Cliff by her side, she dials his number. He’s on vacation. His partner takes her early morning call. He instructs her to call her endocrinologist, the one who irradiated her thyroid. She calls him, but her symptoms are outside his field of specialty, he informs her. She hangs up frustrated and decides to soldier on. “I’ll be fine,” she assures Cliff so that he will leave for work and not worry about her. She has toughed it out for over three years; one more day will not be so hard.
But Cliff feels unconvinced. He writes down his work number and commands her to call him.
Later that morning, after her family has left, Judy’s neighbour Frances comes over for their usual cup of tea and chat. After one look at Judy, Frances runs to fetch her next-door neighbour Fran. They return to find Judy lying on the chesterfield, wearing shorts and shivering. Fran dashes into the bedroom and grabs a pair of slacks and a blanket. Judy—the one who always does things for herself, who never discusses her health, who never talks of her ailment—now lets her two neighbours bundle her up.
Fran asks her, “Where’s the pain?”
Judy points to, but dares not touch, her sore stomach and confesses her whole story.
Fran thinks that maybe it’s appendicitis and is livid at the doctor’s inane advice. They should call Cliff, she asserts, and she takes the slip of paper with his work number on it and calls while Frances offers Judy some tea.
Judy cannot abide the thought and turns her head away. Fran suggests that she make lunch for Judy’s girls at her place. Judy nods.
Frances has to go back home, but Fran stays. Judy feels maybe a visit to the bathroom will help. She rises carefully from the chesterfield and leans gratefully on her neighbour’s arm for the short walk down the hallway. But the bathroom visit doesn’t help. The pain hangs on, her nerves screech at her every movement. She lies back down on the chesterfield with relief.
It’s eleven o’clock. The phone rings. Fran picks it up. It’s Cliff, calling her back. “I may be wrong, but that wouldn’t cause what she had, right?” she asks him, referring to Judy’s hyperthyroidism.
Cliff doesn’t know; he says it’s all incomprehensible to him, this illness stuff.
Fran gets off the phone as lunch is fast approaching. She has to get it ready and bake cookies for her son and for Judy’s three girls. “I’ll ask Frances to keep an eye on you till after lunch,” she tells Judy. She runs out the door under the scudding clouds and light rain to Frances’s place. Although Frances has her own four kids to make lunch for, she pops over several times and takes messages from a worried Cliff. He’s coming home early, and she lets Fran know this when she returns after lunch.
At 5:30 PM, Cliff barrels in from work. He watches Fran leave with a worried backward glance at Judy. He unwraps the fish ’n chips he’d picked up on his way home and coaxes his wife to eat at least a little bit. Fish ’n chips. The last meal of her life. If only they had known, he would’ve gotten something nicer.
Fed and off the couch, Judy takes a deep breath and throws her affliction out of her mind. Life cannot stop just because my innards are screaming, she thinks. Her girls need new running shoes, groceries need to be bought, for it’s Wednesday night, grocery night. She tells Cliff to get the car ready, and she steels herself for the drive to Parkway Plaza. There in the middle of the grocery store, she sways.
Cliff grabs her and half carries half walks her to the car with the girls running along beside them. Cliff rushes them home and settles his wife on the chesterfield. He whips across the street to ask Frances if she can look after the children while he takes Judy to the doctor’s office.
Frances doesn’t hesitate to say yes, and the two race back to his house. They wrap Judy up in blankets.
As Cliff carries her out the door to the car, Judy—ever protective and still trying to hide her illness—calls back to her girls: “We’re just going to the doctor’s. We’ll be back in an hour.”
~~~*~~~~*~~~*~~~
Shunts!
Saliva and blood spew out as the man coughs, startling his father, doctor, and nurses.
“I can’t breathe!”
Dr. Khursheed N. Jeejeebhoy picks up the man’s wrist, feels his rapid pulse, sees the sweat bead out on his forehead, and knows. Damn. His patient is throwing clots, probably from his ulnar veins where the shunt is implanted, and forming pulmonary emboli. They are killing him. Quickly, he directs the residents and nurses to action to try to dissolve these clots, but it’s 1970, and treatment options are limited. Fury fills him at this unnecessary complication. The shunt is supposed to save his patient’s life, not kill him. This kind of medicine is not what he has been raised to do.
Jeejeebhoy started his journey to practising medicine in Toronto as a junior gastroenterologist at Toronto General Hospital (TGH) on August 26, 1935, in Rangoon, Burma. The first living child born to a prosperous lawyer and a musically talented mother and the grandson of lawyers and doctors, he spent his first seven years learning from his devoted maternal grandparents and being cosseted by the servants. His only sister died at eighteen months of a fit. After more miscarriages, his mother once again became successfully pregnant with his only brother. At the same time, the Japanese invaded Burma, causing the entire family to flee to India in 1942—his father with the army overland and him, his pregnant mother, and maternal grandmother, along with a motley group of refugees, in a Dakota airplane flown by Chinese pilots. As they approached the Burma-India border, the Indian Air Force flew out to fight off the Japanese attackers. He went from a cushy life to an uncertain, nomadic one in India; he determined to become self-sufficient. He also decided to follow in his grandmother’s footsteps. He had the innate talent, and she had instilled in him good work habits and taught him that his Zoroastrian faith required him to always look for the divine in his decisions, to think good thoughts so that his words would be good, and to speak good words so that his words would lead to good actions, actions that would help and heal his fellow human beings.
He shot through school quickly, passed the equivalent of grade-thirteen final exams at thirteen years old, and was admitted to Christian Medical College in Vellore, India, at such a young age that he had to study economics and political science for two years in university before being old enough to commence his medical studies. He briefly flirted with surgery—but surgeons have to start too early in the day for his taste—before settling on gastroenterology. He earned his PhD at London University in England and met my mother, his future wife, at West Middlesex Hospital, where he was a house officer. They met because she got salmonella poisoning (not for the last time), and he was the one tasked to tend her. I was born a week before their first anniversary; three months later, we were sailing for Bombay, India, where he intended to set up his practice. But life in India was not as he had envisioned it. The political atmosphere and restrictions chafed on him; a doctor from Canada, on sabbatical in Bombay, noticed and recommended him to Dr. Keith J. R. Wightman, Chair of the Department of Medicine at the University of Toronto and Physician-in-Chief at TGH, as a man well suited for Wightman’s burgeoning gastroenterology department. All of a sudden, we—Jeejeebhoy (my father), my mother, my four-month-old brother, and I—were moving to Toronto, Canada. My father struggled from 1968 to 1970 to build up a practice at TGH as only the second non–Anglo Saxon staff member, after his surgical colleague Dr. Bernard (Bernie) Langer. As the newbie, he got the tough cases, the ones no one else wanted, like this man dying before him now.
This man had been shuffled over to him because of his difficult condition: pseudo-obstruction. This ailment of the gut looks like a physically obstructed bowel but is not; still, it prevents the patient from digesting his food. Far from being daunted, Jeejeebhoy relished the challenge this man brought, and he desired to send his patient home healthy.
When reviewing the case, he had realized that his new patient needed to be nourished for a long time through some method other than eating. The problem was that the current short-term artificial feeding he was using on Langer’s postoperative patients would be insufficient. Looking for better methods of treating him, he talked to colleagues and then thumbed through the literature until he found a research paper in the prestigious Journal of the American Medical Association by Dr. Belding Scribner. Scribner described a new way to artificially feed people beyond the current standard of just a few days. He wrote that he had adapted his shunt—a silicone rubber and Teflon, U-shaped device that allowed for continuing arteriovenous access for kidney dialysis and that had revolutionized the field of home hemodialysis—to feed people a nutritional solution. He called it an artificial gut. Gastroenterologists around the world had been racing after the holy grail of artificial feeding, trying to overcome many problems, including the very big one of how to infuse a solution permanently through a vein, and here Scribner seemed to have found it. Jeejeebhoy wasn’t completely convinced about its efficacy, but in consulting with senior colleagues, he was advised to try it on this patient dying of pseudo-obstruction.
And now, his patient is dying from the shunt. The man moans and grabs his chest. He loses consciousness. He dies. A cry rises from the corner where his father has been standing out of the way of those struggling to save his son’s life. He turns on Jeejeebhoy, demanding to know why the gastroenterologist has just let his son die.
Why did he have to use this technology, this shunt? Why did he have to die? Jeejeebhoy wants to know that, too. He tries to comfort the father, but the man has already turned his back, collapsing at the side of his dead son’s bed. Jeejeebhoy watches for a moment, compresses his lips, turns on his heels, and strides out of the room to the nurses’ station where he meets up with Pat Walker, the head nurse who is thrilled to be working with and learning from such a talented physician, and with Langer. He tells them what has just happened. He cannot believe it. He had followed a leading researcher’s findings to the letter, and it has killed his patient. His patient!
Jeejeebhoy fumes silently for a moment and then declares, “We cannot use this shunt again. I won’t have my patients dying on me. We have to go back to the central line. We’ll just have to start from scratch and do our own thing.” He stalks back to his office.
~~~*~~~~*~~~*~~~
Surgeries and Starvation
The black night envelops the car as it hisses along the road toward Judy and Cliff’s family doctor. But he’s away. Instead, his partner examines Judy, quickly covers her back up, and tells them that she needs to go to Scarborough General Hospital now. She has to see the gynecologist on call. Luckily, the hospital is just across the road.
Within minutes, Cliff has helped Judy into an examining room and up onto the bed, and the gynecologist is examining her. After the gynecologist straightens up, he says that in his considered opinion, Judy has a torsion of an ovarian cyst, which needs to be operated upon directly. “Go home,” he tells Cliff. “I’ll call you when we’re done.” As Cliff drives home, the specialist admits Judy for a laparotomy.
In the operating room, with the GP assisting him, he cuts Judy open, but to his surprise, finds nothing wrong in the pelvis. It’s late, and the organs above the pelvis are outside his area of expertise. He could close up and leave it for the general surgeon to explore in a day or two, but this young mother needs help now, plus he doesn’t want to put her through the stress of an incomplete operation followed by another operation in a day or two. He’s also puzzled by what is causing her excruciating pain and is concerned that she might not survive it for another day. He explores upward.
He removes her healthy appendix, which is standard operating procedure in 1970, and then examines her ileum, a lower part of the bowel, and finds the problem. Ten centimetres from the cecum, about a half-inch of the bowel has died due to a lack of blood supply. He excises the pale tissue and inspects the rest of the bowel to ensure that there is adequate blood supply. It’s pink. He’s relieved. He stitches the two ends of the bowel back together, closes the incision, sends her to recovery, and calls Cliff with the good news at one o’clock in the morning.
Cliff is elated. Someone has finally rid Judy of her terrible pain. She will return to him. Things will go back to normal. His broad smile beams his relief to Fran, who had taken over from Frances and is keeping him company. He and Fran chatter about what has happened and reassure themselves that Judy won’t miss such a small piece of bowel; after all, the bowel is extremely long. The only thing that now worries Cliff is what to tell the children in the morning before they leave for school. Fran suggests saying that the surgeon removed her appendix. That should be light enough not to frighten them. He agrees. And he knows Judy would agree, too.
The days slip by as Judy seems to heal. A Penrose drain attached to a noisy pump speeds up the process by suctioning fluid and infection from her abdomen. But she starts to feel the old pain again, on top of the post-surgical pain. Worse, large amounts of cells and pus start flowing out of her drain. The surgeons discuss this worrying turn. Perhaps the sutures tying the two ends of her bowel together have come apart, causing the bowel contents to leak out into her abdominal cavity and on out through the drain.
A new surgeon examines Judy on September 28, one who knows more about operating on the intestines than the first guy. She is moaning and semi-conscious from the pain. Dr. Michael O’Dwyer decides to X-ray her the next day and operate again. He has the staff inform Cliff.
The X-ray reveals a scary story: her intestines are paralysed and are not working. Judy is wheeled back into the operating room on September 30. O’Dwyer slices her skin, revealing a nice pink peritoneum. So far, things look normal. He slices through the covering over the intestines, and shock halts his hand. Fecal-stained and bloody fluid has flooded her insides from her diaphragm to her pelvis. He gingerly touches the small bowel, now grey-white in colour instead of its usual red. It falls apart. Frowning, he looks at the gall bladder. Its wall is necrotic, and bile has stained it and has spilled onto the stomach, the duodenum, and the liver. He notices a number of yellow-grey patches on the liver surface; later, as the surgery continues, he notices that they are increasing. Wondering how and where the blood flow has stopped, he first feels the pulse of the superior mesenteric artery, the main source of blood supply for the bowels. Nothing. Then he feels the celiac artery. Nothing. The hepatic artery. Nothing. The splenic artery. Again, no pulse. Hesitantly, he checks the aorta. It is pulsing away. Relief. Next, he examines the colon, the large part of the bowel, and tries to mobilize it. But here, too, gangrene has set in. He absorbs this information. From the fourth portion of her duodenum all the way down to the cecum, her bowels are dead, and her omentum, the fat that sits underneath the stomach, is greyish green and lifeless. The contents spilling out of her bowels and the dead tissue have created a rampant infection inside her abdomen. She’s finished.
Still, something moves him to believe that life is possible and not to sew her back up with autopsy stitches and send her back to her room to die. With his scalpel, he swiftly excises thirty-two feet of dead bowel from the third portion of the duodenum to just above the rectum, as well as the gall bladder. He ties off the cystic artery just in case blood flow returns and it starts to bleed. He hunts for the clot that has created this mess and finds it in the superior mesenteric vein—with blood unable to flow out of the digestive system through this vein, it had backed up into the arteries. Eventually, circulation had stopped altogether. That’s how the gangrene had set in. He puts in a one-inch Penrose drain, attempts to stitch the two far-apart stumps of bowel together, stitches her wound up, and sends her to recovery. Now, for the hard part.
“We found a previously healthy bowel grey and friable,” he explains to Cliff later in Judy’s room so that both can hear the news in person instead of over the impersonal phone. Judy seems comatose. “We had to excise her intestines from the duodenum down to her descending colon. Unfortunately, Mr. Taylor, your wife cannot live without bowels. We will, of course, keep her comfortable.”
Cliff reels. Judy cannot die. This crisis is all supposed to be over.
She moans. The pain is flowing over her stomach, and she’s thirsty. She begs the surgeon not to let her die. “I can’t die! I can’t leave yet. You have to do something, anything, to save me.”
The surgeon shakes his head sorrowfully and leaves. All they can do is infuse her with IV glucose and morphine to keep her comfortable until she dies of starvation.
He goes to the coffee room, hoping for some solace, and relates this sad story to his colleagues. One volunteers that he’s heard of a young gastroenterologist downtown doing some sort of work on new feeding technology. Maybe he can help. Anything is worth a try, he thinks. His patient badly wants to live, and her husband already looks lost. He calls the gastroenterologist. Well, the young man asserts, they are not quite ready to try long-term alimentation in the hospital again, never mind in a way that will allow the patient to go home, but he’s willing to try since she wants to live. “Sure, send her over.”
With guarded hope, O’Dwyer tells the Taylors of this possible lifeline. “She might have a chance with this doctor,” he tells Cliff. Judy hears and decides. She has to go.
~~~*~~~~*~~~*~~~
Dr. Cowboy
“I have no problem going in the ambulance. You turn that light on, you turn that siren on, you’re to stop, pull over, and let me out!” Judy is not too happy about all this dramatic fuss over her. The ambulance attendants ignore Judy’s outraged wails, expertly push her stretcher into the vehicle, and slam the doors shut. Inside the artificially lit, cramped space, the frosted, white-lined windows shut out the night, but the doors at Judy’s feet menace her with the possibility of flying open, of sucking her and her stretcher out onto the road as they race down the Don Valley Parkway, known colloquially as the Parkway, to TGH. She passes out and comes to in her new room.
Putrid green walls stare back at her as she looks around wondering where she is. She’s off the stretcher and in a new, proper hospital bed, but the same wad of stained bandages cover up her wound. The same sickly sweet smell perfumes the air. The same warm ooze is slipping over her stomach. Shoes squeak toward her, and she turns her head to see a stocky man with skin the colour of milk chocolate and straight, thick, black hair cut short on the back and sides. He’s dressed in a blue shirt, blue pants, and a striped tie, but no white coat. Standing at her bedside, he pronounces his name. “I’m Dr. Jeejeebhoy.”
A cowboy? A cowboy is her new doctor? “Jeejee,” she guffaws.
Suddenly, she fears that the hospital is going to kick her out. A horse is looking after her, so they are going to kick her out. She screams for Cliff, who hears her as he is racing down the hallway looking for her. Jeejeebhoy leaves to search for her husband.
Cliff rushes in and grabs her hand. “They’re kicking me out. You have to stop them!” she screams. She can’t leave! This is the place they’d sent her to save her life!
“Shhh,” he comforts her. “They won’t. I’ve bought the place. It’s yours, and you can stay as long as you want.”
Relieved, she stops. Of course, Cliff will take care of her. She tells him about Dr. Cowboy.
Cliff is puzzled. “Who’s Dr. Cowboy?” he asks.
“Jee, jee, jee, jee … a horse.” She sees the cowboy doctor pop back in, followed by a bunch of young men and a nice-looking woman. She points him out to Cliff. “Jeejee!”
He introduces himself. “I’m Dr. Jeejeebhoy. Is she always like this?” he asks Cliff. “Is she ever sensible?”
“It’s the morphine.”
He nods and then turns to Judy. In an uncompromising tone, he tells her that he has to examine her to see what they are dealing with. She acquiesces. He undresses her stomach, and the smell of rotting meat grows. His face turns grave. A yellowish liquid is eating her skin. Brown muck and blood ooze between the open stitches that had been laced up the middle of her stomach; only her pleura forms a protective barrier between her innards and the air outside. Tubes emerge from around the hole. The resident beside him can hear faint bowel sounds even though the bowels supposedly have been removed. Her skin is puckered, dried up, and pale. No wonder it cannot hold the stitches. In the quiet, as the gastroenterologist and his residents contemplate what they see, Judy turns to Cliff and begs him not to let her die.
Then she turns to Jeejee, her new cowboy doctor, and begs him not to let her die.
“I have three girls,” she tells him. “Who will look after Cliff and my girls if I die? I have to live. I want to live.” She turns to her husband. “He has to understand that,” she says. “I can’t stay in the hospital. I can’t die,” she pleads again with this specialist. He looks right at her with his intense, cocoa-coloured eyes and nods. She falls back onto her pillows and closes her own hazel eyes. He carefully redresses her and then turns to his residents, while Pat, standing nearby, listens as well. He orders cultures of her wound and urine as well as blood tests. He wants her put on ampicillin until they get the cultures back and know precisely what bacteria they are dealing with, and he wants her on 50 mg Demerol every six hours to curb her agony while reducing the hallucinations from the morphine. He instructs Pat to put her on IV fluids to rehydrate her and give her ice chips for her dry mouth. Water is too dangerous for her to drink; in her semi-comatose state, she might choke on it. He tells Cliff that he doesn’t know if he can keep her alive, but he’ll try. Then he leaves.
His staff scurries around, carrying out his orders, while he spends the rest of the night reading up on nutritional research. Judy has arrived rather too suddenly for him to know what and how to feed her: short-term patients in the hospital hadn’t necessarily needed complete nutrition, but this lady will, as she cannot take anything by mouth; the temporary catheters they currently use will be no good in the long term; and that shunt was a complete failure. He needs to decide what and how to nourish her before talking it over with the pharmacist in the morning.
Meanwhile, the first order of business for the residents is to drain her stomach acid to stop it from leaking onto her skin and burning her. A young man in a white coat with a large snake in his hand approaches Judy’s bed. He explains, in case she comprehends, “We’re going to put in an NG tube. You’ll hardly feel it.” While the nurse stands next to him, he sticks the snake up one of her nostrils.
The pain of it snaps her eyes open, and she becomes frantic. He tells her to calm down and again explains this is to help her.
When she seems calmer, he continues pushing it up her nose until it hits the top with a painful lurch, and then he snakes it down toward the back of her throat, at which point he orders her to swallow. Judy seems perplexed. “You won’t choke. Swallow.” She swallows. The nasogastric tube slides down her esophagus and into her stomach. He tapes it to the side of her nose and her face so that she won’t pull it out.
He leaves, and Pat catheterizes her urinary tract. She hooks the catheter up to a bag attached to the side of the bed. And when Judy calls out for water, she gives her ice chips to suck on and keeps an eye on her. The cool wetness soothes Judy’s mouth. Once she’s finished them, Pat fetches an IV kit, punctures her arm, and hooks her up to an IV bottle on a pole next to the bed. Glucose and ampicillin flow into her vein. Finally, she injects her with Demerol. Judy falls asleep. Cliff walks out of her room to head for home, his head down, his feet dragging. He is afraid.
~~~*~~~~*~~~*~~~
Garbage-Bag Dressings
It’s been thirteen days since Judy’s last meal. Her body has cannibalized her fat and muscle for nourishment, but it’s not enough to feed her brain. She speaks slowly with effort. Her liver is sluggish. Her skin is inelastic. It and the whites of her eyes are yellow; her urine is tea coloured. She is starving to death.
At home, Jeejee considers the problem. What food do people require? How best can I help her? She needs something for life, something to mimic real food, not something that will make do for a couple of weeks. A normal diet comprises protein, carbohydrates, fat, vitamins, trace elements, and electrolytes. That’s the combination she needs, yet he wonders how he’ll give her fat. American and Swedish researchers have been warring over which fat is best for IV infusion and whether one needs fat at all. The Americans shun fat, for the product that they had devised had proven toxic, and they believe it makes the liver fatty. But the latter doesn’t make sense to him. Fat is in our diet for a reason—and Judy cannot go a lifetime without it. He rereads the papers published by Prof. Arvid Wretlind of the Karolinska Institute in Sweden. Wretlind has developed soybean-oil-based IV fat emulsion, which has been used in Europe for several years. He decides that he will use this fat emulsion. Still, he wonders, will it lead to fatty liver? He has a theory about that.
Now for the next decision: which trace elements shall he give Judy? He pulls out animal studies from his stack of literature. Because veterinary science is often ahead of human science, these studies are often more informative. He peruses his stack of journals late into the night until he’s satisfied that he has a viable plan. He retires to bed.
Early the next morning of Wednesday, October 7, Jeejee visits Dieter Baun, the hospital pharmacist, in the basement of TGH. They discuss what to feed Judy. Baun had turned the hospital pharmacy into a sterile production centre for sterile solutions when Jeejee and Langer had first started working with hyperalimentation (or nutritional IV solution) for their post-operative, short-term patients. Thus, he is already set up to create Judy’s alimentation that day. They decide to customize commercial solutions by injecting the nutrients they specifically want into the ready-made bags. This method will speed up the process of manufacturing Judy’s alimentation. Satisfied that Baun has things under control, Jeejee leaves for G South, the ward Judy is on, to arrange for a way to get the alimentation into Judy’s veins.
Since the fiasco with the Scribner shunt, Jeejee has reverted to using temporary catheters because they’re the fastest and most proven way to infuse alimentation. But these catheters are problematic. Because they’re made of plastic, they not only fall out easily, but they also stimulate tissue reaction, allowing clots to form on the inside of the tubing, clogging it up. The catheters become unusable after only a few days and need to be replaced. If this feeding succeeds, they will have to look for a better type of line. But that’s in the future. For now, Jeejee calls in a respirologist to insert the plastic catheter.
The respirologist swabs Judy’s chest and punctures it as she lies semi-conscious in her hospital bed. He feeds the thin, clear tubing into her vein until its tip reaches her heart. Suddenly, Judy cannot breathe; she sucks air in and out, in and out, in and out. Swiftly, he stabs her chest, slips a tube through the hole and down between her ribs to the area around her lungs, and attaches it to a machine to suck out the air that’s squeezing her lung and pushing her trachea to the right. He leaves the tube in until the hole heals shut. Her trachea takes until seven o’clock in the evening to shift back into place. Still, her temporary catheter is in, and he tells the resident that they can start running the alimentation, which has already arrived on the floor from the pharmacy.
Pat knows the routine from their experiments on post-operative patients. She hangs the alimentation bags on Judy’s IV pole. She enrobes them in big, black blood-pressure cuffs. She connects the bags one to the other with tubing, leaving the last tube hanging down, its end capped. She pressurizes the cuffs, lets the alimentation flow down to the end cap, pulls the pole closer to Judy, uncaps the end piece of tubing, and connects it to the catheter sticking out of Judy’s chest after first ensuring it is clear of debris. She watches the alimentation flow down the tubing and into Judy for several minutes. Satisfied that there are no clots, she leaves. Later, she comes in to find Judy smiling. She has a nice buzz going.
Pat smiles back at Judy’s questioning face. “It’s the alcohol,” Pat explains. Then she tells Judy a story. Jeejee’s lab partner at the University of Toronto, ABR (as everyone calls Alan Bruce-Robertson), was looking for subjects to test how alcohol in IV form affects humans. Pat had volunteered. She wanted to be a part of Jeejee’s fascinating research. ABR asked her about her drinking habits to determine her suitability as a test subject before he signed her up. Unfortunately, she’d made the mistake of thinking her definition of being a drinker was the same as his, and if she’d also known that ABR starts his mornings boiling his coffee on the stove and drinking it straightaway in one gulp and prescribes the most wickedly effective cough syrups, she might’ve had second thoughts. As it was, he hooked her up, and she was soon giggling and lolling about. There was no way she could get home on her own, and so he loaded her up into the back of his station wagon and drove her home. She was sick for a week.
Between the story, the buzz, and the Demerol, Judy laughs helplessly. But a few hours later, she has a hangover. She and Pat agree that she cannot go through life drunk. But for now, the alcohol acts as a little calorie packer, and Jeejee will find a better solution down the road.
After she finishes her story, Pat gets up and rubs Judy’s legs. She moves them up and down, bending and straightening first her left leg and then her right, in order to get the blood circulating. It soothes Judy, and she falls asleep.
Pat contemplates that horrid wound. How are they going to dress that big hole so that it stops leaking? She talks it over with some of the other nurses, and they come up with a novel idea: they’ll dress her in garbage bags. Since it’s time to change Judy’s soaked and stained dressing, they’ll do it now.
Pat carefully peels off the old dressings. She cleans the wound and packs in some gauze. One of the nurses has found some green garbage bags. Pat lays these over her stomach and over her dressings. They slide off. She asks another nurse to get some special tape, and while she holds the garbage bags in place, the nurse straps them on with three or four adhesive straps, which the nurses then lace up.
Judy wakes up, looks down at what they’ve done, and giggles. She’s wearing a green garbage-bag corset! The nurses laugh with her and tell her that, since she no longer leaks, they can move her to a chair. This will keep her muscles and blood moving.
They sit Judy up, swing her legs over the side of the bed, pause to let her catch her breath, and then help her stand up. With Pat on one side and a nurse on the other, they coax her to head toward the chair. She’s so tired and in pain that she doesn’t want to move. They encourage her and gently, step by step, walk her to the chair and lower her down. Pat sits beside her and talks to her while holding her hand. It comforts Judy.
Judy looks out the window and sees a tree, the tree that Cliff will come to park under when he visits her every night. Its vibrant leaves against the deep blue autumn sky connect her back to life. She breathes it in. Her body slowly sinks in on itself.
Pat pats her hand to tell her it’s time to return to bed and undergo her hourly dressing change. Once Judy is back in bed, the nurses put on a new garbage-bag dressing, prop a sheet tent over her torso to give her some dignity, check her alimentation, and then leave her to sleep for a bit. She sleeps fitfully.
Cliff walks in, the first visit of many, afraid of what he will find. He’s not yet used to this new reality. He sits next to her and takes her hand in his. He broods. Jeejee had told him that if Judy can survive all the surgeries to come, then he can probably keep her alive on his feeding system. But Cliff wonders what the future will bring. The evening drags until it’s time for him to return home.
Judy wakes up to see Cyndy, Julie, and Miriam climbing up and down the tree outside her window, grabbing the branches to pull themselves up or swing down. Every so often, they stop, point at Judy, and laugh. Horror and shame fill her, and she starts to cry. Suddenly, they rise up at the end of her bed, peeping at her. Then just as suddenly, they disappear. She looks around fearfully, but she’s free of the hallucination. She falls asleep.
~~~*~~~~*~~~*~~~
Let Judy Die
Judy’s mother sits beside her, as she has every day, watching the daughter who was not supposed to die dying. She sees her daughter lying semi-conscious in the stark hospital bed under a sheet tent, smelling like rot, looking emaciated. Tubes are coming out of her from everywhere, and pumps are all around. She cannot see how her daughter will live. She misses her lively daily telephone calls.
Only a month ago, she and Judy spoke every morning on the telephone, talking about her grandchildren, talking about Cliff, talking about things a mother and daughter are supposed to talk about. With Percy having died in 1963 from a heart attack, the phone calls had become even more important to her. But now, she sits in silence beside her silent, still daughter in the midst of the noisy machines keeping Judy alive. This is their new morning ritual.
Every morning, Marjorie eats breakfast, gets dressed, and goes down to TGH to sit in this green room with her dying daughter. Meanwhile, her daughter, who speaks little and hardly knows that her mother is there, doesn’t eat breakfast and doesn’t need to get dressed. Marjorie hates this new morning ritual.
Suddenly, she has had enough. She stands up, picks up her purse, and walks out of the room and down the hallway to the gastroenterologist’s office. Sun streams in through the window behind the cheerful young secretary. The blue-walled waiting room is empty. She asks to see Dr. Jeejeebhoy and is told he will be coming out of his office soon. She sits down. A strange-looking calendar with odd caricatures all over it leers down at her from the wall. She stares into space, seeing the image of her dying daughter, steeling herself against tears. Men don’t like weepy women.
He comes out with a patient, sees her, and comes over.
“Hello, Mrs. Russell. What can I do for you?”
“I need to talk to you.”
“Certainly,” he says and leads her into his office.