17 Hours in an Emergency Ward

JUNE CALLWOOD October 15 1954

17 Hours in an Emergency Ward

JUNE CALLWOOD October 15 1954

17 Hours in an Emergency Ward


At a big-city hospital like Toronto StMichael’s the door marked EMERGENCY is always open. Here’s the graphic story of day and night inside that door, with the men and women who patch up a city’s wounds and don’t ask awkward questions

THE EMERGENCY department at St. Michael’s Hospital in downtown Toronto is across the hall from the ambulance entrance. It is possibly the busiest emergency department in Canada. To that entrance come ambulances bearing seared victims of fires, bodies broken and torn in car accidents, aged people whose hearts have faltered. Last year 84 were dead when they arrived and 36 others died in a matter of hours. Up the shallow steps beside the ambulance entrance stumble swimmers who have cut their feet, young toughs with bleeding heads and housewives with soot in their eyes. The red light over the open doorway reads “EMERGENCY” and if burns day and night.

Inside is a 22-room suite of operating rooms, offices, waiting rooms and examining cubicles which cost $200,000 and was custom-built only a year ago. The two operating rooms are lined with cool green tile and stainless steel and glass cupboards; the examining cubicles are partitioned to the ceiling and have stretcher tables covered with spongerubber mattress and a shadow-proof green curtain for a door; the waiting rooms have blond wood modern furniture upholstered in pastel leatherlike plastic. The unit has acoustic ceiling, walls that are waxed wood or cream tile, glass-brick windows with insets of rainbow glass that can be opened, and special, sound-deadening flooring.

In the surgery area the floors have a new type of spark-resistant material, the first floor of its kind in Canada. The utility room has an autoclave, an ovenlike apparatus used in sterilizing, that can

sterilize instruments in ten minutes instead of the usual half hour. A special cupboard contains enough sterile dressings to provide for a major disaster and another warming cupboard keeps blankets heated to counteract t he effects of shock.

During seventeen hours I spent in this department from eleven in the morning of Friday, Aug. 13, to four the following morning, it was empty only once—for eighteen minutes beginning at 2:20 in the morning. The rest of the time was occupied with a human pageant that was sometimes

dramatic, sometimes clownish and often pathetic. One hundred and fifteen people were treated that, day and thirteen cases were considered serious enough to require the patient to stay in the hospital. One of the most dangerous cases was an 85-year-old lady suffering from a stroke; the least serious was a young man who had a sliver removed from his palm.

Only half of all these patients paid a fee for their treatment, a percentage only slightly lower than normal. The hospital makes no charge in

cases of extremely low income, pensioners and unemployed people. Sometimes the accounts office makes its decision not to charge a fee solely on the evidence of the patient’s address; more often there is some delicate questioning. Like all hospital emergency departments, St. Michael’s is run at a deficit of thousands of dollars a year. Over a year just under 30,000 patients are treated in the emergency and 12,000 pay no fee at all. The rest pay an average fee of only $1.25.

One of the patients who was required to spend the night in the hospital was a man who called himself Murphy. He arrived shortly after noon and was led by the arm up to the nurses’ desk by another man, who rapidly disappeared and left. Murphy grinning happily at the nurses through the blood trickling down his face.

"I’m Irish,” he announced cheerfully, “and I’ve got lots of blood, lots of good Irish blood.”

Sister Regina Marie, a nun who is supervisor of t he emergency department, paused on her way to lunch to glance at the new arrival. “That’s one of our regulars from 77 Shuler,” she sighed, going out. “It’s a flophouse.”

Murphy, joyously drunk, was giving the nurse his name and address. “Murphy,” he dictated. “1 have no address but at present I’m staying at 77 Shuter Street. I fell against a bed a while ago and I seem to have cut my head. I’m an Irishman, you know.”

The nurse, Edwina Tonelli, led Murphy along the hall to one of two operating rooms of the emergency department. She helped him off with


17 Hours in an Emergency Ward

his shirt and into a hospital gown. “Up here, sir,” she said and Murphy climbed on the operating table and crossed his feet. He instantly was bored with this and sat up.

“Gifnme a cigarette, eh?” he asked.

“Would you mind {jutting your head down, sir?” Miss Tonelli asked, preparing to shave the hair around the wound.

“Anything you say, dear,” Murphy replied. “Are you Irish?”

The doctor arrived, Dr. John Moffat, a f all, tanned interne from Galt who graduated from medical school last year. He peered at Murphy’s still-bleeding cut and went out to scrub his hands and put on a sterile mask and rubber gloves.

Although all instruments and dressings are sterile, emergency operating rooms make no attempt to duplicate the elaborate sterilizing procedures of formal operating rooms. Most of the patients wear street clothes, complete with shoes, while their minor cuts are stitched or burns treated. Anything more serious is sent to the surgery upstairs, where a general anaesthetic is available. Emergency operations use only local anaesthetic, obtained by hypodermic injection in the affected area.

“Go ahead and sew, doc,” Murphy declared when Moffat reappeared in mask and cap. “I’m an old soldier and I’ve been stitched before. Don’t give

a damn about me.” He lay quietly on the table.

Moffat touched the cut gently. “That’s pretty deep,” he muttered.

“I didn’t really fall against a bed,” said Murphy suddenly. “Gimme a cigarette, eh doc?”

Moffat anaesthetized the cut and snipped off the ends of a few nicked veins, called bleeders, to stop the flow of blood. He began to stitch, starting with three stitches that neatly divided the cut into slightly gaping quarters.

“How long have you been drinking, Murphy?” he enquired conversationally.

“Since seven this morning,” said Murphy, his voice muffled by the cloth over his face. “That’s because they woke me up then.”

“Why did you start so early?”

“Nothing else to do.”

“Did you have some breakfast?”

“Ha! I had wine for breakfast.”

“He has a record of unconsciousness,” the nurse told Dr. Moffat softly. “He said when he came in that he’d been unconscious for half an hour.” Her hands flitted among tl e instruments.

“We’ll do a neurological on him to make sure there’s no bleeding under the skull,” Moffat said.

As soon as he finished the tenth and last stitch and applied an elastic bandage, the interne began the neurological examination, given as a matter of routine to every patient with a head injury. A series of tests on reflexes and perceptions in various parts of the body, it indicates if blood is collecting against the brain. Brain injury or even death can result if the clot is undetected. As a further precaution in the case of head injuries which have caused unconsciousness, the patient is kept in hospital 24 hours for observation.

The doctor pricked Murphy’s right shin with a hatpin and Murphy, oblivious, continued his genealogical research with the nurse. “You must be Irish,” he was saying, “you’re so pretty.” When Moffat pricked the left shin, Murphy sat up with a roar: “Whattya doing there! Stop that now!” Murphy had other disturbing reactions. In some

a¿ of his face he couldn’t distinguish between the blunt and sharp ends of the pin. Some joints of his legs had no reflexes. While this examination was going on, Sister Regina Marie, the supervisor of the department, came into the operating room.

Murphy immediately put his hands over his face and said weakly, “Oh, Sister. I’m sorry.

“When did you change your name?” asked the Sister casually.

“I didn’t want to let you down,” Murphy continued brokenly. “I’m awfully sorry.”

Murphy, as he had called himself in a hopeful attempt to escape the notice of Sister Regina Marie, is one of the hundreds of derelicts the hospital has helped or tried to help over the years. In his case Sister Regina Marie two weeks before had called Alcoholics Anonymous to help him and had arranged for him to be treated in an alcoholics clinic. Using a special fund the emergency department has for such cases, she paid a taxi driver’ to take Murphy to the clinic. Murphy returned a few days later to say, truthfully, that the clinic had been too full to take him. Sister Regina Marie then gave him 25 cents for streetcar fare to return to the clinic. This he spent on beer.

“He’ll have to be admitted to the hospital, Sister,” said Dr. Moffat. “He has a record of unconsciousness.”

“We’re going to keep you under observation for 24 hours,” the Sister told Murphy, who was still apologizing. “Just to make sure you’re all right.”

“I didn’t bring my things,” said Murphy unhappily. “They’ll steal my razor and my clothes, back where I live.”

“We’ll send for your things,” the Sister reassured him. “Don’t worry, they’ll be all right.”

The next patient in that operating room was a young construction

worker who darted in with nervous, shooting glances around him. His jeans were whitened by cement and a torn shirt revealed skin tanned the color of brown shoe polish. He had a jagged cut at the base of his thumb.

“What did you do it on?” asked Dr. Moffat.

“On a piece of bead. You know, corner bead —molding.”

The doctor nodded and drew up into the hypodermic syringe the anaesthetic solution of one percent novacaine. The young workman flinched as the needle went in.

“Don’t look,” said Moffat hastily.

“That’s where you’re making your mistake.”

Noticing the man’s agitation, Nurse Tonelli said soothingly, “Once the needle is in, you’re all right.”

Dr. Charles Campbell, a slender, bluejawed senior interne who is studying surgery, poked his head through the operating room’s swinging doors. “John,” he called, “have you seen the guy across the hall?”

“Is that the one with the ulcer?” asked Moffat, stitching away on the torn hand.

“Yeah,” said Campbell, coming into the room and pulling his mask over his face. “It’s perforated or perforating.”

“I don’t like to say this,” said Moffat, “but I’ve

never seen a boardlike abdomen, have you?” He was referring to the rigid abdomen that is the classic symptom of a perforated ulcer.

“Sure,” said Campbell. “When this guy came in he had a real one you could sit on. It’s softened up quite a bit now.”

“Damn,” said Moffat softly. “I missed it.” He finished stitching the construction worker’s hand.

Now there were eight patients in the emergency department. A fussy middleaged man was busily explaining to the other nurse on duty,

Margaret Noble, that he had been suffering from a rash for six days. She decided this stretched the use of the word “emergency” too far and referred him to the hospital’s skin clinic. He departed, crestfallen and reluctant. Murphy, no longer so ebullient, was being bathed in a bathtub by an orderly in preparation for his admittance to a men’s ward. St. Michael’s emergency contains a room with two bathtubs for cleansing the hospital’s skid-row clientele.

The man with the perforated peptic ulcer was lying very still under a blanket on a stretcher table, waiting to be taken to the surgery upstairs. His face was pale and wet from pain. In the waiting

room a man in a business suit who had caught his finger in an Addressograph machine was cradling the injured digit in his other hand; he was waiting for X-ray plates to be developed. A shabby epileptic, with lonely pale-blue eyes, was being examined in a cubicle; he was explaining to the doctor that he couldn’t get his breath. Dr. Robert Cowan, one of St. Michael’s staff eye doctors, was fishing five tiny chips of steel from the right eye of a workman in overalls; a lady shopper, her eye streaming, was waiting her turn to have a cinder removed. Moffat, the interne working in the surgery, had just finished putting a pink elastic bandage over the six stitches in the construction worker’s hand.

It was nearly three in the afternoon and a hot wind was blowing traffic noises in the back door of the emergency department when a small frightened woman in a shapeless dress came into the operating room. She had cut her thumb deeply on a chopping instrument in the factory where she worked. She spoke no English and she began to writhe and sob on the operating table as Moffat attempted to inject the anaesthetic.

Maclean’s photographer Peter Croydon, an Englishman who speaks several languages, spoke comfortingly in Italian to the terrified girl. She answered, volubly and Continued on page 83

Continued on page 83

4. A.M. The scream of a siren or the squeal

of brakes are familiar signals at Emergency, i

It happens more than a hundred times a day.

17 Hours in an Emergency Ward


hysterically. Croydon spoke to her again.

“She thinks,” he reported to Dr. Moffat, “that you’re going to cut her thumb off. I’ve assured her there isn’t a knife in the room.”

The young doctor paused, shocked. “Good lord,” he said. He bent over

the girl’s hand again and Croydon continued to explain, over and over, that the doctor was not amputating.

The afternoon wore on. A man came in with steam press burns on his hands and forearms. An old man, whom police found unconscious in the gutter, was brought in and quickly diagnosed as the victim of a stroke. His eyes were glazed and frightened in his unshaven face as he was wheeled away on a stretcher table to a ward upstairs. A young man in overalls entered shyly; his hand had been crushed in a vise. A student nurse whisked him toward

the elevator to have it X-rayed upstairs. Three people had cut their fingers, another had broken his glasses and cut his eye and another had fallen off a ladder and twisted his leg. A striking blonde, accompanied by a dapper young man, strolled in sensuously and explained that her sunburned face had become infected. Dr. Campbell treated her with penicillin.

“1 believe,” he announced deadpan as he watched her swaying out of the emergency on her high heels, “that I was able to cure her completely.”

An ambulance backed up to the

ramp across the hall and the driver wheeled in a lovely tanned woman whose face was contorted with pain. Her husband, a big distracted man, explained to the nurse that she was three months pregnant and seemed to be “losing the baby.”

“The pain, the pain,” the woman kept moaning. “Oh, oh. It hurts.” The nurse and interne wheeled her into the resuscitation room, gave her an injection of morphine and phoned upstairs to locate a bed. The girl was wheeled out of the emergency a few minutes later, her husband anxiously hunched over her sleep-glazed face.

One of the doctors paused to examine a notice recently taped under the counter of the receiving desk. “If a man comes into Emergency with the following description,” he read, “please notify detective office at headquarters immediately at EM 3-2121. He is believed to have been involved in a holdup and may have been shot . . .” There followed a description. The interne showed no surprise; criminals are no novelty at St. Michael’s. The hospital, located between the downtown section and the Jarvis Street breeding ground of criminals and alcoholics, is used by the police of two precincts for arrested men and women. Three days previously a thief had been caught robbing a jewelry store and had been brought in to have a police bullet removed from his leg.

It was nearly four o’clock in the Emergency, the hour when minor operations such as the removal of cysts are scheduled in the small operating rooms. This relieves the big operating rooms upstairs of trivial surgery. Dr. Paul McGoey, a handsome, white-haired orthopaedic surgeon who is one of St. Michael’s staff of teaching doctors, had arranged to perform small operations at four. He arrived, as always, with a flourish and a swirl of internes and nurses.

The first operation was to remove a mole on the chin of a student nurse. McGoey made the operation a lecture on the technique of skin grafts while a h ilf-dozen doctors and nurses watched with fascination. He cut a piece of skin smaller than the end of a pencil eraser from behind the girl’s ear, scraped the tissue from it until it was so thin it curled and then set it in the profusely bleeding hole from which the mole had been cut.

As McGoey began to stitch, John Moffat, the interne on duty in Emer-

gency, had to tear himself away. On his way to the receiving desk he passed Campbell, the senior interne. “You oughta see McGoey,” he told him, with an admiring shake of his head. “He’s got a skin graft in there about five millimeters wide and he’s putting ten stitches in it.”

The receiving desk, when Moffat reached it, was a scene of babbling confusion. All of the principals in a three-car collision, flanked by ambulance drivers and shepherded by the blue bulk of a motorcycle policeman, were trying to explain their injuries to Sister Regina Marie. Deftly, she sorted them out.

Two teen-aged girls who appeared to be no more than shaken up were asked to wait in the waiting room, an old lady who was trembling on the arm of her bent husband was taken to an examining cubicle and a middle-aged woman bleeding from a forehead cut was wheeled to the operating room that McGoey and the girl with the mole had just vacated. Moffat went with her and while the nurse cleaned the woman’s forehead he began, systematically and thoroughly, to scrub his hands again. He looked up at the nurse, blond Dorothy Wylie, who had just come on duty. “You know how much money internes make?” he asked casually. “Four cents an hour.” He had already earned sixteen cents.

Pretty Stitches for a Face

Miss Wylie laughed and indicated with a nod the woman on the operating table. “I got some glass out of the cut when I washed her,” she told Moffat. “She says she hit the windshield.” The doctor nodded.

After he had slipped his hands into rubber gloves, Moffat injected anaesthetic into the wound and began to probe for glass. The woman lay quietly but her breathing trembled.

“How many stitches will it take?” she asked in a Lancashire accent.

“About seven or eight,” said the doctor.

“Oh dear,” the woman said with a weak smile. “I’ve got enough wrinkles now.”

“I’ll put some pretty stitches in,” replied Moffat, threading a curved needle with black silk thread. He began to sew, pushing the needle in one side of the cut, down and up the other side. He pulled the thread almost through, tied a double knot with a pair

of clamps and snipped off the ends with short scissors. The room was quiet and the Englishwoman closed her eyes and seemed to sleep.

The old woman who had been in the same accident was still lying half asleep in one of the cubicles, undressed and covered with a blanket. Her husband, who had been driving, was hunched in the waiting room, his hands over his face. The motorcycle policeman was patiently questioning him. The teen-agers, stolidly chewing gum, watched without expression.

“How about his wife?” nurse Audrey Hughes asked an interne softly.

“She’s got a fractured skull,” the doctor answered under his breath. “You can feel it.”

An attractive woman hurried up to the receiving desk, looked around her furtively and leaned over to whisper to the nurse, Mrs. Hughes. The nurse calmly escorted the woman to an examining cubicle and returned grinning. “That one,” she announced, “was bitten by a monkey.” This was an unusual incident, even for St. Michael’s where human bites are so common that they arouse no comment. An interne hurried down the hall to examine the monkey bite.

Another policeman marched in, supporting an unsavory-looking old man. “This is Michael King,” the policeman said matter-of-factly. “He’s about sixty and he has no home. He says he’s got a tube in him and it’s come out.”

Just a Pony But He Kicked

Audrey Hughes examined him and decided his immediate requirement was a bath. She turned him over to the orderly. Mrs. Hughes turned back to find a disheveled woman leaning weakly against the desk with a dirty towel over her ear. “My horse kicked me,” she said in a shaking voice. “I’m not hurt, just scared.” The nurse removed the towel and discovered the woman’s ear lobe had been torn in half, from the wide flaring edge down to the canal.

As they walked to the operating room, the woman explained the accident. “She’s a gentle little thing, this pony, really. Tonight she got out of the gate and I was standing in front of her trying to stop her. I don’t know just how it happened. She’s a highstepping little thing.”

Mrs. Hughes left the woman on the operating table, still explaining, and hurried to adjust an oxygen mask over the face of an 85-year-old woman rushed to hospital by ambulance when she suffered a stroke. The other nurse, Dorothy Wylie, began gently to wash the torn ear.

“Oh, that hurts!” the woman shrieked. “Can’t you just pat it, do you have to rub so hard?”

“I’m sorry,” said Miss Wylie, “you’ve got some stable dirt around your ear and we have to get it off.”

“Just hang on,” said Dr. Pat Farrell, a senior interne. “This is the worst of it.” The woman continued to cry.

Farrell decided there was some danger the mastoid had been injured and instructed Miss Wylie to send the patient upstairs for X-rays. In the hall the stretcher table passed the old woman and her husband who had been in the car accident. Smiling wet-eyed at one another and walking with small, careful steps, they were just preparing to leave. X-rays had shown that she didn’t have a fractured skull after all.

The next visitors were an interesting trio, a tall embarrassed young man who turned out to be a house detective at the Royal York Hotel, a slim bleached blonde in a tight black dress and a weaving, expansive man wearing a

blazer with a yacht club crest.

“I fell down,” the man announced.

“Name?” asked Audrey Hughes.

“John Smith.”


“Just say Royal York Hotel,” answered the man, with a grand gestuie. The detective said nothing, and looked away.

Mrs. Hughes noted the adhesive tape on the man’s forehead and led him to one of the operating rooms. She left him with Miss Wylie, who removed the tape and discovered a long deep cut.

“What happened here?” she asked.

“To tell the truth,” the man returned gailv, ”1 get hit with a bottle. Can you imagine anyone hitting me with a bottle?”

“I can imagine it,” commented Miss Wylie coldly, and went out to get Dr. Moffat.

While Moffat stitched the yachtsman’s torn head, the blonde strode stormilv up and down the hospital corridor, smoking furiously and glaring at the nurses who watched her impassively. The hotel detective stood quietly against the wall and also watched the blonde.

Moffat came out of the surgery ahead of his patient.

“Do you know who that guy really is?” he asked Mrs. Hughes. “He’s a big industrialist named —---', presi-

dent of his company.”

“He is, is he?” retorted Mrs. Hughes grimly.

Thé industrialist sauntered up to the desk and was joined by the blonde and the detective.

“Do you have any Blue Cross or other insurance to cover this?” Mrs. Hughes asked sweetly.

“I have,” he replied, “but I’m not going to report this. Just send me the bill.”

The woman whose ear had been kicked by a horse was being brought back from the X-ray room, on a stretcher table, followed by McGoey and Farrell. The X-ray plates had shown no damage to the mastoid; all that remained was the tricky chore of sewing the ear. McGoey examined the ear and outlined to Farrell how it could best be done. A few minutes later McGoey reappeared in his street clothes and said goodnight. Tt was then 10:30 and he was operating again the next morning at eight.

“We’re on the line at eight tomorrow,” he called to Farrell from the operating-room door.

“Right, sir,” answered Farrell, carefully pumping novocain into the woman’s ear lobe. He patiently began the first of more than twenty stitches, while the woman moaned and writhed and protested. Mrs. Hughes scrubbed her hands, slipped on sterile gloves and held the ear to help him.

“Remember the New Year’s Eve,” Farrell asked her, “when we started at six and I was suturing until morning? One fat lip after another. One fellow said to me ‘I’ll put in a good word



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for you with Dr.---’ and I said

‘Sure, you do that.’ But it turned out

he really did know Dr.---and he

did put in a good word for me. You just never know.”

“Did you see the man who came in two nights ago walking on his ankle bone?” said Mrs. Hughes. “He was drunk and he’d fallen and broken it and the stump of the bone came right through his foot, stuck right out the end of it. He said he didn’t feel a thing.”

Dr. Farrell shook his head and put in another stitch.

“He died, didn’t he?” he asked softly.

“Yeah,” said Mrs. Hughes. “Poor fellow had some other things wrong with him too.”

After that they worked in silence, except for the moaning of the woman the horse kicked.

In the other operating room John Moffat had just finished sewing a gash in the head of a happy inebriate who had arrived in a blood-soaked shirt with a towel around his head.

“I really enjoyed sewing him up,” he said as he returned to the receiving

desk. “He kept saying ‘God bless you, my boy.’ ”

Miss Wylie’s voice could be heard down the hall, talking to the patient. “You didn’t have a hat with you. You were wearing a turban.”

The man arrived at the desk, giggling. “1 was sneaking out of the house and I fell down the stairs,” he explained. “God bless you all.” Miss Wylie put him in a taxi and paid the driver the fare to take him home.

Moffat checked the clock behind the receiving desk and discovered it was a minute after midnight and he was

free to go to his bedroom in the hospital. Just at that moment a young man came in and displayed to Mrs. Hughes a hand that had been punctured with an ice pick. Moffat turned to Dr. John Harbinson, a small meticulous interne who was on duty until eight the next morning.

“I’ll flip you for him, John,” he said in a low voice.

“No, no,” protested Harbinson, “you go to bed.”

“Look,” said Moffat, “I’ll stay if you’d like another hour’s rest.”

“No thanks, I’m fine. You go along.”

A siren screamed outside and both men stiffened, but the sound died away in another direction.

Moffat left and Harbinson began to examine the punctured hand. Mrs. Hughes and Miss Wylie appeared, looking chic and pretty in summer dresses, and sait! goodnight to Mrs. Margaret Harkens, an attractive nurse who would be on duty until eight. They were interrupted by the ringing of the phone. Mrs. Harkens talked briefly with a doctor who said he was bringing in a young man who had just suffered a heart attack.

“Excuse me, please.” A swarthy man in a corduroy jacket appeared suddenly at the desk. “I drive a cab,” he said tersely, “and I had a fight with someone and he hit me in the nose. I think it’s broken. Can they fix it tonight?”

“It all depends,” said Mrs. Harkens.

“Well, I gotta be at work tomorrow,” the man said as Dr. Harbinson led him to an examining cubicle.

Two hefty women in soiled print dresses came in and looked around unhappily. One had a handkerchief wrapped around her bleeding hand.

“My sister,” the other said, “she cut her hand on a pop bottle.” Mrs. Harkens took the woman into the operating room just vacated by the woman with the torn ear.

The cab driver returned and made a phone call. “Hey,” he said in a husky whisper, “the damn thing is broken in two places . . . Yeah! . . . All he did was look at it and he says it’s broken in two places ... I could hardly hreathe ... I’m about dead . . . My head’s aching.”

A wispish man in a blue windbreaker came in and explained confidentially to Dr. Harbinson, “My arm is sore. Someone twisted it. It hurts a hit and when I move it I can hear a scraping noise.”

“When did it happen?” asked Harbinson.

“About five o’clock,” said the man casually. It was then 12:55 in the morning. Harbinson decided to have the arm X-rayed.

A police wagon drew up outside the ambulance entrance and two tattered and bleeding men were helped out by two policemen. As they walked toward the emergency entrance one of the policemen muttered “They’re going to look after you in here but you be on your best behavior, hear me!”

Too Drunk to Lie Still

The two prisoners were assigned to the operating rooms, one on each table. One, a black-haired, blank-eyed young man in a filthy cotton jersey, was shaking convulsively and unable to talk. The other, an older, blond man, had both eyes closed and one was swollen the size of a golf ball.

“They were fighting in the cells,” the driver of the paddy wagon explained. He went out, leaving a constable to guard the two men. As he was leaving he waved to two other policemen who were leading in an old woman who was gripping her left side in agony.

“Some guy broke into her home and assaulted the old lady,” one of the policemen told the nurse. Mrs. Harkens, on Dr. Harbinson’s request, phoned the internes’ quarters for help. Dr. Farrell, who had been in bed a little more than an hour, arrived a few minutes later and decided both arrested men in the operating rooms had broken facial bones.

“We can’t X-ray them tonight,” he told the policeman, “because they’re too drunk to lie still.”

The man with the swollen eye began to thrash his arms and legs, in support of the statement. Mrs. Harkens strapped him to the table to prevent him falling off. She noticed on his right arm the tattoo “In loving memory of my dear mother.”

Two plain-clothes detectives brought in a young girl. “She’s going to act as interpreter,” one explained to Mrs. Harkens. “The old lady who was assaulted only speaks Ukrainian. Has the doctor finished examining her yet?”

Mrs. Harkens went in search of Dr. Harbinson and left the detectives scowling at the little man who was waiting for his arm X-rays. The interpreter, a pale girl of about 18 who had knotted a scarf around the curlers in her hair, tried to avoid meeting anyone’s eye. Mrs. Harkens was back in a moment.

“The old lady’s getting dressed,” she reported. “She won’t let the doctor look at her.”

“What the ... !” exploded one of the detectives.

The orderly wheeled the two prisoners, one at a time, out of the Emergency and into an elevator that would take them to the wards. The man with the injured eyeball still had his eyes closed but the other had recovered

sufficiently to give the nurse his name. They were followed by the two sisters, walkin? slowly with their arms linked and staring at the huge white bandage the injured one wore. Farrell returned from the X-ray room, still sleepy-eyed, and told the little man that he could go home, his arm wasn’t broken. Farrell watched him go and announced he was going back to bed. A moment later the detectives and the old woman left with the interpreter, who was talking earnestly in Ukrainian.

“What do you know,” remarked Mrs. Harkens. “The place is empty!” It was 2:20 a.m.

The Emergency held an eerie silence, the cubicles and operating rooms dark, the halls bare of hurrying white-clad figures, the furniture in the waiting room Sifeless as a store window. Dr. Harbinson went into the internes’ room to nap. A three-legged cat walked sedately down the hospital corridor, glanced incuriously into the Emergency and continued his stroll. Outside the summer night was flecked with the off-on gleam of neon signs. Eighteen minutes passed.

Brakes squealed in the courtyard around the ambulance entrance and two men walked quickly to the desk.

“So you’re on duty tonight, are you?” they said to Mrs. Harkens and she grinned back at them. The younger, a big heavy-set man, fished a notebook out of his pocket and thumbed through until he found an empty page. The older man, smaller and grey-haired, leaned against the counter. Both were detectives from No. 1 Precinct.

“How about those two we sent you who were fighting in the cells, eh?” asked the big man, and Mrs. Harkens handed him the hospital reports. He began to copy down the names.

“Hey, look at this ” he said suddenly to the other detecti.e. “This name here. Isn’t that guy a drug addict?”

“What did he look like?” the older man asked Mrs. Harkens and she described the prisoner who had been unable to talk. “That’s him all right,” the man nodded. “Just spelled his name different, that’s all.”

The big man went on writing. “When I was a motorcycle cop out of No. 2,” he said idly, “I used to alternate accident victims, one to Emergency at St. Mike’s and the next to the General. One night I took six of them in, three to each hospital.”

“Nice of you to split them up,” commented Mrs. Harkens.

“I’ll never forget the time I brought a prostitute into St. Mike’s,” continued the detective. “She was in bad shape. Well anyway, Sister was in the room and this prostitute used the worst language I’ve ever heard anyone use and I’ve heard some awful language. The Sister just looked at her and didn’t say a word. After a minute the prostitute stopped and if it was possible for her to feel cheap, she did. The Sister just looked, and didn’t say a word.”

“They never do,” added the other detective, looking at the records again. “Say, nurse, do you think either one of these guys is gonna die?”

When the detectives had left, their place at the counter was filled by an arrogant young man who announced he was the bouncer in a night club and he was in a hurry. Mrs. Harkens examined his bleeding knuckles and took him to the soak room to wash his hand.

“Look,” he told her insolently, “I’m the manager of this night club and I haven’t got all night to stay here. I’ve got to close the place up. How long are you going to be?”

“I’m sure they won’t close the place without the manager,” answered Mrs. Harkens smoothly, giving him an injec-

tion of penicillin. She stared at him.

“I’m going to tell Hush about the way this place is run,” the man announced. Mrs. Harkens said nothing.

St. Michael’s has been involved, through its emergency department, in almost every Toronto disaster. Victims of streetcar accidents, rooming-house fires, and car accidents are brought to St. Mike’s, as well as would-be suicides at the rate of one a week and victims of heart attack and stroke.

The most dramatic of all disasters St. Michael’s has known was the dawn a few years ago when the steamship

Noronic burned and a hundred of the victims were rushed to St. Mike’s Emergency.

“There were people everywhere,” recalls Dr. Pat Farrell who was a first-year interne at the time. “Ambulances arriving all the time, reporters and photographers trying not to get in the way, nurses and doctors coming in to help without being asked—you never saw anything like it.”

Farrell worked for hours on the roasted flesh of victims, saw a dozen die and heard the screams of those who were alive. Finally the Emergency

was cleared and he was preparing to leave, aching with strain and weariness, when he saw a small huddled figure at the end of the waiting-room bench. He touched the man gently. “Can I help you?” he asked.

The man looked up and Farrell recognized one of the Emergency’s regulars from Jarvis Street who sometimes sneaked into the waiting room to sleep in warmth.

“Yes, you can help, doc,” said the man peevishly. “You can tell everyone to be quiet. I’ve never known it to be so damned noisy in here.” it