Saturday Night at St. Mary’s

Duffy, Peter

You know the drill. When you are fresh out of training as a family doctor, and your teachers offer you a job in ER, you take the shifts that no one else wants and are grateful for the privilege. In 1976, permanent Saturday nights were all mine at St. Mary’s in Montreal.

It was a big year for the city. The world’s best athletes came to play in our half-finished stadium that looked like a giant toilette bowl, a description all the more apt as we then flushed tens of millions of dollars down its crumbling concrete maw for the next three decades. And just three months later, in November, René Levesque changed Canadian politics forever by becoming Premier of Québec. But it was at the beginning of that year, on a Saturday night in January, when St Mary’s was changed forever.

For weeks there had been local news stories on French television stations about increasingly overcrowded emergency departments in hospitals at the east end of the city. Frustrated doctors led television cameras through corridors jammed with patients on stretchers and sounded grave warnings about such conditions being a dangerous impediment to proper care. They implored government officials to “do something.” What that “something” might be they didn’t say.

Soon there were reports that similar overcrowding had inundated larger, more resource-rich teaching hospitals--Sacre Coeur, Hotel Dieu, Maissoneuve Rosement—but the Two-Solitudes mentality of the day considered these institutions to be apart from us and on the French- speaking side of academic medicine. English speaking media even opined how the spread of ER chaos had so far confined itself to the other side of The Main or Boulevard Saint-Laurent. Linguistically, culturally, and psychologically, this narrow strip of asphalt cleaved the heart of Montreal into its right and left ventricles of us and them. But when their hospital administrators began turning away ambulances by baring ER doors with padlocks and chains, I knew the historic fault line would not protect us.

The first of the McGill hospitals to be inundated by the inevitable overflow of patients was the Royal Victoria. Days later it was the Montreal General. The Reddy Memorial and The Queen Elizabeth, both located further to the west, soon suffered the same fate. Now English language radio and television warned the public to seek medical help in private clinics and, if possible, avoid all emergency departments. Nevertheless, when I headed in for my usual Saturday-night shift at St Mary’s, I knew we would be next.

A cluster of ambulances had made their own traffic jam in the hospital parking lot. When I stepped through the entranceway the noise level alone told me the situation was critical. Occupied stretchers lined the hallways. Triage nurses had to yell to make themselves heard. Some had even pushed all the waiting-room chairs to the wall and commandeered the area to treat the more urgent cases. Webs of tangled intravenous tubing dangled from a variety of plastic bottles, the entire network suspended from a makeshift arrangement of silver poles.

In the corridors orderlies scurried to and fro, setting up portable oxygen tanks and connecting nasal cannula to patients gasping for breath. Interns hunched over bedside railings, scribbling furiously and leaning closer in to better hear a man or woman try to describe their symptoms.

Everyone looked scared.

I threaded my way through the confusion and entered the equally crowded nursing station where some of our staff were busy on the phones initiating a fan-out of calls that would summon reinforcements. But my attention was drawn to the physician I was here to relieve. He too had been on the phone, but was now slowly lowering the receiver to its cradle. He’d been my mentor, and not a man to flinch in a tight spot. The slack-jawed droop of his face caused my own breathing to go still.

“What’s happened,” I said.

He swallowed, but didn’t reply. By now the others in the room had noticed the chill of his silence.

“That was the police,” he said. “As of now we are the last hospital that’s open on the island of Montreal.”

I don’t know how we got through that night.

An image of three million people encircling our lone ER kept crowding into my mind.

And the ambulances kept coming. Some of the drivers, having never been west of The Main, radioed that they were circling on unfamiliar streets and couldn’t find us. We talked them in like planes lost in a fog.

I also don’t know if those who died that night might have lived if we weren’t so overwhelmed.

When morning came, the onslaught of ambulances finally stopped. However, we still had hours of work ahead of us, arranging follow-up for those stable enough to be discharged home and transferring or admitting the rest.

It was during this mopping up phase that an elderly man sitting bolt upright on a stretcher kept catching my eye. His bristly, short white hair stood erect, his blue eyes shone with a sapphire intensity, but, most noticeable of all, tears streamed down the deep corrugations of his rugged, lined face.

“Monsieur, are you in pain?” I said in French,
“No, Monsieur,” he said, his voice resonant with a deep warmth that belied the agony in his gaze. “Then what is the matter?”
“I can’t stop crying.” “Why?”
“I don’t know.”
“Has something happened to upset you?”
“Not recently. I have been sad for a long time, but now it is getting worse.” “What are you sad about?”
“The war.”
“World War Two?” I said.
“No, the Korean War. I’m a veteran of the Canadian Army, and was taken prisoner by the North Koreans. It happened over twenty-three years ago…”

I sat down on the side of his bead and, midst my colleagues’ sorting through the remaining less serious cases, listened to him describe a long ago world of torture, cruelty, sadistic deprivation and perpetual cold. After the armistice of 1953, he was repatriated to Canada, but up until now had avoided seeking any treatment for the recurring flashbacks, nightmares and depression because he might be considered less than a good soldier.
I had to ask it. “Why did you pick last night of all nights, after waiting decades, to seek treatment?” He smiled shyly. “My wife called the paramedics on me. She thought I was going to shoot myself.” “Were you?”
“I don’t know.” “What about now?”
He grinned. “Now I’m going to shoot myself if you don’t let me out of here. Last night was worse than the war.”

I made sure he had no gun, gave him an appointment to see me in my office the next day, and released him into the custody of his wife. The two of them showed up as planned, and they both became my patients for the rest of their lives.

The same phenomenon occurred over and over in the coming weeks, but not just with myself. Many more displaced patients who found themselves in our ER because of the on-going closings continued to see our doctors for follow-up visits and, eventually, made St. Mary’s their hospital.

After six weeks the provincial government obtained an injunction banning the chaining of ER doors under the penalty of fines and/or imprisonment. Out came the bolt cutters, and off came the locks.

The crisis was over, at least for a little while. But after that day, fifty percent of my practice hours were conducted in French, whether as a family doctor or working in ER. It was the same for most of my colleagues throughout the hospital, and to this day, patients come to St. Mary’s from beyond The Main. 

Theme: History | Histoire 
Theme: Community | Communauté
Theme: Patients | Patients 
Theme: Health Care Delivery | Prestation des soins de santé 

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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