COUNTRY DOCTOR | Rory O'Sullivan
Early morning. The sky was black with just a hint of blue, a promise of light to come. Black sky above, dotted with stars, and hard-packed snow below. A motionless scene, except for little eddies of gray moisture hanging on his breath.
He stepped out onto the deck, felt the familiar creak of old wood underfoot. The familiar creak of old bones in his lower back. The Ottawa Valley opened before him, rolling snow broken by the jagged silhouette of evergreen trees. It was a ten-minute drive down the road to the hospital. He pulled his knitted toque firmly down around his ears. Wearing his favorite heavy flannel and jeans. His father’s uniform. A protective cloak of masculinity, a suit of armor against a hard world. His stethoscope folded into his back pocket.
The telephone had roused him from the depths of a fitful sleep. He had been swimming in inky nothingness, bobbing around the edges of his own awareness, and then the shrill siren call back to the surface. The phone needled into his unconscious, a pestering electronic mosquito. He awoke to the reality of his Spartan bedroom, all earth tones and practical hard edges.
A call from the nurse on duty. An elderly man, an old-timer from a nearby farm, struggling to breathe. Needed a doctor.
Time to dig in and go to work. Bare feet on the coldest hardwood floor in human history. A moment of vanity, a peek in the bedroom mirror, at puffy cheeks and eyes rimmed by dark circles. Hair sticking straight out at horrible, defiant angles. Three days of stubble rappelling down a soft chin into the wilds of his neck.
He found his way down the old wooden steps to his truck. The engine protested for a second, roused from its own peaceful slumber, then roared to life. The vessel of nighttime tranquility dashed against the rocks of human invention. Then, as if to add insult to injury, the grim crackle of breaking ice as he scraped the windshield clean. Just a small area, as big as his head, enough to create a pretense of safety.
He was needed urgently. He had been many times before. He moved quickly, efficiently, but he did not rush. It was an exercise in hubris, perhaps. The first shot across the bow of the villainous fates. I will not march to your drum. I will not be held captive by circumstance. I will meet your challenge in my own time.
His headlights washed over the driveway, glinted off the scalloped banks of plowed edges. Later in the day, he would be gruff and unpleasant. He would be annoyed at having his night cut short, at having lost out in the ritual daily calculus of adequate sleep. He would feel foggy and slow. But now, cold air and adrenaline had jostled his perceptions into razor-sharp focus, and he felt a rush of energy.
He wound down the old road toward the highway. He thought, as he had many times over the years, that it was a special kind of privilege to be awake and out in the world at this mysterious hour. To be awake and alive while others tossed and turned and snored. To have a head start on the day, to avoid the too-bright, too-common traps of busy breakfast tables and coffee line-ups. To be up before the sun, milking every second of experience out of a day yet to be written. A moment to be savored, perched on a diving board above the mundane.
In these long minutes alone, he sometimes wondered what it would be like to live in the city. He imagined people confident and cocksure, everyone moving with arrogant purpose. Bustling past him, just this side of impossibly manicured and chiseled and clean. Like movie characters, life imitating art, but without irony, without the excuse of costumed pretend. Cinematic perfection on a backdrop of glass and concrete. A figment, perhaps, of a small-town imagination. Fantasy or not, he felt suddenly grateful for the familiar gentle curve of the road, the crunch of ice and gravel under the tires. The counter-intuitive warmth of solitude. The city was far from home.
He moved through the village and into the parking lot of the old hospital, where an empty ambulance was idling. How many hundreds of times had he crossed this threshold? He saw, without seeing, the faded stripes of yellow paint on the asphalt, the red brick scored by wind and rain and cigarettes. The automatic doors buzzed open, and he took the final step from his internal world into the world of others.
The main floor of the hospital was empty, but for the noises coming from the little treatment room off the main corridor. Surrounded by the hum of fluorescent lighting, the walls papered with jarring, cheerful posters in primary colours. On a stretcher in the centre of the room, a rail-thin old man gasped for air. Wide eyes, head tilted back as though treading water. Seasoned, leathery skin over prominent bones. A ball cap cast off to the side. A flannel shirt not unlike his own, open to show a chest that thrust quickly up and down to allow little bursts of rapid breathing. A splash of silver chest hair.
They knew each other, of course. They had crossed paths during a few of his bleary-eyed, early-morning covert missions to the bank and the hardware store. Their kids had mowed each other’s lawns at different stages. There was a dim memory of an episode with a kidney stone, and a dispute about zoning at the town council. All of this was noted and put aside.
The nurse on duty puttered around the bed, adjusting the heart monitor, tweaking the oxygen tank on the wall. She was an experienced hand, an old soul with eyes that radiated equal parts compassion and steel. She made no comment as he moved to the bedside. He wondered, as he often did, how she had spent the long minutes before he got there. Hanging between the call for help and the arrival of the cavalry, watching and marking time.
His training took him through the next steps. Filed down to essentials by years of practice. Muscle memory, like driving a manual transmission. Short, sharp questions. The stethoscope, the totem of all his power, releasing the secret crackles and pops and wheezes and whirs hidden deep in the essence of this man’s body. Cool, dry hands feeling chest and neck and pulse in swift, careful sequences. All the time, in his mind’s eye, stacking the details like blocks. Things I know. Things I don’t know. Things I should do. Things I shouldn’t.
Things I can fix. Things I can’t.
He did not think about this man’s life. About his wife and kids, his years spent struggling against the yoke of work, how he liked his eggs cooked and how he felt about this years’ goaltending. These were irrelevant details. These were dangerous details.
A crisis of emphysema, he decided, and prescribed the appropriate treatments. Oxygen, inhalers, steroids, antibiotics. The recipe, not that old in the great scheme of things, but carrying the weight of gospel passed down through generations. He conferred with the nurse, and patted the old man’s hand. A reassuring squeeze on the arm, a way of piping confidence from body to body. A motion that had the benefit of being both professional and genuine. He let his gaze fall over the weathered face. He saw a future he would never accept for himself, and of course could not avoid.
He retired to the other side of the room to give the treatments a chance to work. He found a carafe of slightly burnt coffee and helped himself. An old mug with a jolly cartoon Santa beaming out at him. The piping hot liquid, gloriously bitter, seemed to draw the ache from his neck and shoulders. He allowed himself a long look at the clock, and considered how he would ration himself in the coming hours. This would be the first of several cups today.
He stood outside in the parking lot. The treatments were working, and his patient was rapidly improving. Another episode to be logged and forgotten. All at once special and routine. The contradictions in his job made him dizzy sometimes.
The sky was brightening, and light was slanting sideways over the snow. Crows called to each other from the nearby power lines. Somewhere a snowplow chortled across pavement. Hot coffee and cold air, elemental, mixed in the centre of his chest.
Time to start the day.
Rory O’Sullivan is a practicing family physician in Toronto, Canada. Before starting in medicine he worked briefly in newspaper journalism, and has maintained an interest in creative and non-fiction writing. His medical career has taken him to rural and remote parts of four different Canadian provinces, and he feels privileged to have collected the extraordinary stories of people and places along the way. He is passionate about Indigenous health, care of the elderly and care of vulnerable populations.