I didn’t know you could die from a bleeding nose.
He is shouting at me, face deep in a sodden towel. His voice is muffled and faintly gurgling but there is a resonance that I could never mistake. He tells me to go through the red light-he can
sense me stopping and will not have it. Go, go, he bellows from his towel. I look up over the dashboard to get a better view of the intersection and he is at it again, for Christ’s sake go, he says, the last word warbled in blood. I step on it and hear a horn blast as I pass through the intersection. For the first time I feel the power in the car, the intent in the roar beneath the floorboard and wait for the sound of a siren that doesn’t come.
He took blood thinners. A pill every day depending on how thick his blood was. The hospital would leave a message to take a half a pill more or less, depending on the blood test. His blood was never just right; the dose was always changing. I remember as a kid trying to fIgure out what that meant-having blood that was either too thick or thin. They would ask on the phone if he had a beer or ate a lot of green vegetables. Oh yeah, a great one for salads, he is.
We pass the elevated railway crossing and he groans into his towel as the road drives us up with a sick-joke promise of becoming airborne, but the Galaxie 500 is a flightless bird and it only shudders over the tracks, plumage of rust disintegrating with each mile and moment. If it could bleed it would. He is quieter now.
It must be too thin. Mike took the message, scribbled it down on the pad and then slapped it on the fridge. I remembered how the note paper, with the thin line of adhesive along the top, looked like a little yellow awning flapping into the room. But I didn’t read what Mike wrote on the paper and I doubted the old man had either. The note was still there when we left, broad and pug-nosed smack in the middle of the great avocado-green face of the fridge.
Again with the horn, but I have picked up too much speed to consider hitting the brakes going through the yield. I can sense the old man almost smile through the bloody towel. I reach under the seat to find the handle that allows me to pull myself forward, clawing the dark, scattering the beer cans and paper refuse before catching it. I yank the latch and hump the seat forward but the manoeuvre doesn’t work; I am left peering over the dash as I perch on the seat’s edge.
Now the wind funnels through the car as I push it past sixty down Archibald Street, past the bungalows that dapple and fade out of my peripheral vision, past the oncoming shapes of the packing houses whose dimensions elongate and lean in, features and colour fading into monoliths. Take the left, take the left, he says, he knows where we are. He knows perfectly well.
I am still counting the times that I have been in the driver’s seat. The perforations in my learner’s permit are not yet completely creased, my signature is still fresh under the box checked off to indicate my willingness to cede my organs, my first solemn duty. I have a routine of adjusting the instruments around me, something that Mike mocks by way of shouting-rear flap! … rear flap operational-but it is a routine: side- and rear-view mirrors, seat, and finally the radio. It calms me before the ignition catches, a ritual as real as the placement of a dashboard virgin or the scrotal tumble of fuzzy dice, and not half as distracting. Today I had no chance to go through the rites. I found him a towel and wiped off my hands before grabbing the keys from the kitchen table and that was it. I am paying the price now, having to hike the seat up on the fly, jerking my feet forward and having one slip off the accelerator, producing a chrissake from the old man. Side-view, rear-view, seat. I glance at the mirrors. I am triangulated by the time we are at Marion Street and I scream into a left turn, the one light I make the one I have to make-and I want him to say something or at least let on that he thinks that I have made the turn through traffic, against the light. I pull the car out of the wake of a bus, cutting in front of a Nissan, and feel a wobble in the handling accompanied by his groan. I look over to see his hands compressing the towel against his head, pale half-moons of his nails against the darkening sky. Oh, he says.
He had a bad heart. It was scarred by rheumatic fever. Licks the joints but bites the heart, I heard someone say once, but it wasn’t him because he didn’t talk about such things. Achilles heel, I remember thinking one time after he slapped me. If you could find the heart you knew it would be bad: a bag of evil humour. Rheumatic fever left him a valve that disconsolately flapped like the note on the refrigerator. His heart skipped beats and was prone to throwing off clots, as if to spite the other parts of his body for harbouring such a heart. He refused to have a mechanical valve put in, made a fuss about it too, right there in the clinic, in front of all those doctors and nurses and other patients, probably for the benefit of his boys. Mike and I just sat there, shrinking under the twin fists of fear and shame. Blood thinners were the only compromise he would make.
Blood is pounding in my neck and chest and now everything seems magnified. On my left we pass a park, violently protesting its colours, throbbing green now out of the depths where the river cleaves it. It isn’t illegal; he’s right there, that’s what a learner’s permit is. Everybody’s got to learn. What? he says because I have said this out loud. I feel the car roar beneath me, underneath the rigours of its frame, sensing the cylinders and valves and the controlled explosion at the core of it all.
Mike left the night before and had not come back this morning. I checked his room every hour during the night but the bed stayed empty. The house was quiet for the first time in weeks but I wanted him to come back. You’re like the old man, he said, you need voices around the place. Mike didn’t need voices, or if he did it wasn’t the old man’s: raised, directed, tinged with mundane profanity. Even before the old man and I sat down for breakfast and he started rattling on about the faggot, before I had even gone into his room to find the drawers of the dresser half-closed in a parting salute, I had the feeling that he wasn’t coming back.
The tires whine through the turn that takes us onto Goulet and he has pretty much stopped groaning. I ask him how he’s doing and he nods his head. The hair on the back of his head tapers down to a point on the nape of his neck, matted and dewed with sweat. It was easy to understand why he didn’t talk about his heart, why he refused the operation and took prescriptions as suggestions: he is a man who works with his hands, who defines himself physically. On a refinery tower, at that height, balancing on a platform in the toxic plumes, a man’s scars should come with an explanation more exotic, more heroic than just the best interests of his family.
And he worked, that much you had to give to him. He was a horse or a mule or whatever animal is best made to suffer incremental indignities in the guise of labour and not be aware of any of it because it came with a paycheck. That was what Mike said. He wouldn’t have said that to the old man. He knew the old man’s limits, he seemed to be testing them every day in a debate conducted at high volume-until something was said last night, and now he was gone. The bed wasn’t touched.
The road descends once I pass Desmeurons Street and I am alone now; no learner’s permit or stricken father or brother gone except for the map of himself on the bed sheets. I am alone with the sound of a glass breaking on the ground and with his voice rising. What will I say to the doctor? They will want to know how this happened. A mechanism of injury, a term remembered from trips to the emergency room when Mike or I would look the nurse in the eye and tell stories of errant doors-it swung in, I thought it would swing out-or graceless athletics exploits. I am alone with my explanation: he is on blood thinners, this happens, he drinks, my fist swung into his face like a door from a darkened recess. He pushed me and I felt threatened.
Go, go, he says and I wonder what he means. With his head wrapped and tottering I wonder what he has ever meant. He says go; it means nothing more. I am flying, catching all the lights, the illuminated cross of the hospital now in view and looming. It is absolutely quiet, as though the engines have cut and we are now drifting, finding our place without effort, everything is silent and effortless, falling in love or asleep, falling apart.
That lasts for a moment. The car is under my control, it is my movements mirrored in metal and rubber. Nothing is effortless. I staggered him with my right hand and before the torrent started I saw the look in his eyes. Everything had changed. Straight ahead lies the Norwood Bridge that leads into the city centre, a left turn would take me out of the city completely, to limitless highway and space but I flip the indicator on to signal the right turn for the hospital. The sky framing the hospital is split by a mantle of cloud the colour of burnished metal and it is this image, this lack of shape and colour that leaves me feeling lonely, only it’s not that but something that feels like loneliness. I don’t know what it is but it has an authenticity I will remember: the dishwater light, the ache of my right hand, the taste in my mouth. He throws open the door and gets to the emergency room entrance. I hope he will ask me to come in with him, to have my hand looked at, but no. I reach out and turn the radio on. I will go in later, to give the doctors his particulars and watch them stanch the bleeding. I will see his pallor and the harried action around him as his life is contemplated. But now all I do is sit and let the radio drown everything out for no reason other than there are words in my head and a voice that is rising; my words, my voice, and there is nothing so ugly as a man coming into his own.
What kind of challenges does this family face? (Read: what are their social determinants of health?)
Does this story affect how you will be as a doctor in the future? Why or why not?