Chapter One: Footsteps

Emerson Regional Hospital

ADMISSION REPORT

Date: 15.04.96. Time of Arrival: 21:20
Patient: Alice Redfern.
Age: 7 years, 3 months. Birthdate: 03.12.89
Parents: Henry and Frances Redfern
Address: 14 Crestview Heights, Huron West, ON.
Phone: 705/725-4311
Father work: 705/856-2947 x4562

Family Physician: William Hannah MD 705/656-0686

Chief Complaint

Fever, severe headache. Light sensitive. Appears disoriented. Episodes of agitation and screaming, followed by extreme lethargy. Holds fetal position, arms covering head. Resists attempts to remove them. Some rigidity in neck and back. Not responsive to questions. No recognition of family physician. Resists restraint procedures for diagnostic tests.

History of Present Complaint

Flu-like symptoms, headache, nausea, vomiting, onset–72 hours.
Severe headache, altered consciousness, onset–16 hours.

Family System Review

Social Condition: Canadian Caucasian.
Father: Henry Redfern, professor of geology, Huronia Polytechnical College.
Mother: Frances Redfern, homemaker.
Siblings: Sarah Redfern, Age: 14, Grade 9, Oran Heights High School.
No pets.
Diet: Standard Canadian
Behaviour: Mother reports patient is an average student in Grade 2, Orde Road Public School. Describes child as active but with tendency to be withdrawn. Refers to her as a day-dreamer. Father reports child as usually placid and talkative. Parents report strong attachment to sister, Sarah.
Physical Exam

Temp: 103.5 F.
Blood Pressure: 110/70 mm.hg.
Pupils: somewhat dilated
Reflexes: Minor asymmetric paresis.
No apparent sensory loss. Hears but no response to questions.
Ability to vocalize.

Lab tests: CSF, EEG, Blood, Urine, Stool, Lumbar Puncture, Completed 23:56 Medications: Sedation: 14 mgs diethanoil

Comments

Closes eyes in response to questioning. No response to departure of parents.
Repeated loud vocalizations, “Sarah, are you here?”

Mother very agitated. Uncertain about time of onset of headache and other symptoms. Father shocked by severity of child’s symptoms.

Gerry Godwin MD.
Victoria Milliken, MD.
Hector Dubinsky MD
Gloria Estavez RN
Charlotte Empey RN

Admission completed 16.04.96 @ 1: 28
Room: Pediatric Isolation: 2 East. Rm. 2-–57.

Chapter One: Footsteps

I was waiting for Sarah. I’d never heard her footsteps on the glassy rubber of these hall floors, but I’d know them anywhere. As I held myself still so my breath couldn’t get in the way of her sounds, she popped up inside my head, walking tall down the hallway, her long legs bringing her directly to my door. On her feet were her saddle shoes, all polished navy blue and white, and her white socks were carefully folded just above the bump of her ankle bone.

Yesterday, before Mom and Dad brought me here, I watched Sarah polishing those shoes. I watched before Dad laid me in the back seat of the car and before the bumpy car ride began with my Dad driving fast and Mom screaming, “Henry, watch it! Henry, careful”, and the wool blanket scratching my cheek as I slid across the slippery back seat.

I watched Sarah polishing as I lay on her big green bed, its bedspread soft on my head. Her Bugs Bunny was tucked in beside me. Sarah sat on the floor cross-legged, a small box beside her, sheets of newspapers messy all around her.

“See, Alice, this is the first polishing and the most important thing is to make the shoes look like they’d never seen polish in their entire life.” Her long fingers flew as she unlaced each shoe. “They have to look exactly like the day I brought them home. Remember?”

I remembered that new shoe day. I was in the backyard digging Alice’s Famous Earthworks, which is what my Dad called the big hole I’d started because I wanted to get to the other side of the world. Just before our car pulled into the driveway with Sarah sitting tall in the front seat beside Mom, I’d begun to worry about what had happened to my running shoes. Mud squished up from their insides and the velcro straps stood straight up. I scraped at the muddy ties with my fingernails but still they wouldn’t close. Mom hated me muddy and if she saw my shoes she’d spit, “Grubby little tomboy”. I was still scraping when the car door opened and Sarah’s leg stretched out. Her new shoe shone as if it were a sparkler. I only saw shoe. Mom didn’t notice my shoes.

The first polishing happened two days later. The shoes still shone bright to me, but not to Sarah. “See these scuff marks Alice, they happened at school today.”

You can’t polish running shoes. Mom threw mine in the washing machine.

Sarah shuffled the newspapers around her. “Step Number One, Alice, is to find old newspapers. Use the papers in the kitchen cupboard. Never ever take papers from the pile beside Dad’s chair.”

She made two tidy squares of papers. “Step Number Two is to give each shoe its own square of paper.” She placed a shoe on each.

Then she speeded up, her hand plunging into the small box beside her and pulling up a long white bottle. She held it up for me to see. “If you get just one speck of this white polish on the edges of the blue, it’s finished. Everyone will know. And you have to let it dry, I mean really dry. Then you get this cloth here- just this one. “ She held up what looked like my old face cloth, “And rub hard,” she said, “hard, hard. But only the white part, remember. And the white part will shine again, as if there’s never been polish on it. But don’t do any of that ‘til you’ve finished with this blue creamy polish in the little jar here.” She pulled out a small round jar, untwisted its top and pulled out a rag greasy with navy polish. “To put it on, fold this rag around your baby finger and dip, but only a little at a time. Watch.” Carefully she wrapped the rag around her finger, dipped it in the polish, then began to stroke the surface of the blue leather, chewing her lower lip. The rag never touched the white part. Not once.

Watching Sarah polish made the pounding in my head almost disappear, until my mother’s voice interrupted.

“Sarah!” She called from downstairs. “ I’ve not heard a single note from that piano in the last two days. I want you downstairs, sitting on that bench in two minutes, do you hear me?”

Sarah ran to the door, “Yes, I hear you Mom, I’m coming down right now,” Then she turned to me and hissed, “Alice, get in your room. Fast.”

I tried to move but my arms, my legs, my toes, even my fingers were cement blocks and my head was twirling in a circle over me.

Sarah was hurrying to put the container tops on. “Quick, Alice. You know how Mom gets if you’re off your bed after lights out.” But when she glanced over at me, her eyes opened wide. “You’re really sick aren’t you!” She knew that I wouldn’t be able to leave her bed, no matter how scary it was that Mom might find me. I’m never supposed to leave my bedroom after I have been put away for the night. Especially when I’m sick.

“My head hurts.” I said.

“Come on, you silly, I’ll help you.”

After she helped me back into my bedroom she promised she’d return to finish the polishing as soon as she’d practised. “Anyway it’s better this way. The shoes will be all dry by then. Perfect for shining. “

I never got to see Sarah’s shoes all polished, not that night anyway. But I did hear her downstairs telling Mom about my head.

“Mom, we’d better check on Alice. I heard her crying when I passed her door. She says her head hurts.”

“Now Sarah, enough of your diversionary tactics. Practise’”

“But Mom...”

“Enough Sarah, I’ll see to Alice soon enough.”

I don’t know how much later it was before Mom appeared in my doorway. She held the phone at her ear.

“Hear that scream, Dr. Hannah? she said. “Can you hear her? She won’t stop and I have to peel her arms from her head just to look at her. Her colour is awful – chalky white and she’s burning up!”

Mom pressed my arms to my side while Dad wrapped me tight in the scratchy grey wool blanket before carrying me downstairs. The car was on the street in front of the house, its engine rumbling, and I smelled the horrible gas smell. Sarah raced down the front steps holding out Bugs Bunny.

“Wait! Hold on! “ she called out as Dad was putting me in the back seat. Sarah pushed Bugs onto the car seat beside my head.

Mom grabbed Bugs. “Oh God, child. Not that thing! It’s filthy!”

Sarah pulled at my father’s arms so she could whisper in my ear.

“They’ll bring you right back, Alice. I know they will. And if they don’t’ I’ll be your first visitor. Along with you know who.”

That was yesterday. Now as I waited for the sound of Sarah’s shoes in the hall, their polished brightness shone inside my head. They were bringing her closer to my room and they knew exactly which door was mine. I saw her, too, her jacket bulging because she’d stuffed Bugs underneath. Then, I imagined her face beaming when she first saw my big bed -plenty of room for Bugs, and her too. And as we’d snuggle in, I’d tell her all about what had happened to me since she whispered in my ear.

I’d tell her:

“Mom and Dad left me on top of a narrow bed, high up from the floor and a fat nurse with yellow eyes pulled curtains around me, making the room skinny and stuffed with people who wore stiff white coats that snapped when they moved. Their faces hung over me, their mouths opening and closing. ‘Alice! Alice!’ they kept calling, so many voices everywhere. ‘It’s Dr. Hannah, Alice!’ he said, only l didn’t remember his face. ‘Tell us how old you are Alice! How many people do you see? Do you hear me, Alice? Answer me, Alice.’ But my tongue was like my wool socks when I get a soaker so I couldn’t answer. Then the curtains swished apart and the bed started to move, the sheets pulled tight around me and the yellow nurse at my head, pushing, pushing. ‘There, there’ she was saying, ‘you’ll be just fine.’ But the lights in the ceiling sped past fast and my eyes stung and I held my head tight so it wouldn’t spin away. The nurse wheeled the bed into another room where she put me onto a table so cold l started to shiver all over. She wrapped me in sheets so my arms couldn’t move. Then she pushed me onto my side and spread herself large and heavy over me, all the way down to my waist, her breath hot in my ear. Another nurse whose face l never saw was at my feet, her hands stinging my ankles as she pressed herself over my legs. ‘Hold still’ she kept saying because I was kicking. ‘It won’t take long’ she said. But it did. Then a man in green came in and stood where l couldn’t see his face. His sticky rubber fingers pressed on the small spot at the bottom of my back and he pushed the needle stinging hot into my back, all the way inside. I barely heard his voice because the yellow nurse kept hissing, ‘There, there. This is for your own good. You’ll be much better now.’ Then I was in the hall again and a new nurse stood at my head. Her shoes squeaked as pushed me slowly down the long, quiet halls . The ceiling lights were grey, not yellow, and everyone was sleeping. This nurse was all pink, her hair a silver cloud around her head, her eyes sparkling blue and her voice soft. She touched my cheek and said she had a little girl like me, only she was grown up and her name was Sarah. When we got to this room, she lifted me into the bed and she was warm and soft like the pillows on your bed. She tucked me inside the stiff sheets and placed something hard with a button in the middle into my hand. ‘This is in case you need help.’ she said. ‘When you press this button, the red light above your bed will glow and someone will come.’ Her shoes made a loud squeak as she turned and she disappeared out the door, closing it behind her. She never came back. “

As I’d tell Sarah what had happened, her eyes would grow huge and her eyebrows would travel up her face so that deep pleats filled her forehead. Then she’d hold her head in her hands and shake it slowly. Suddenly she’d pretend she had a big surprise, throw open her jacket and pull out Bugs Bunny from underneath even though I knew he was stuffed in there all along. We’d both snuggle into him then, as if we were home.

Sarah’s picture suddenly disappeared from my head when I heard another set of footsteps coming down the hall. I didn’t recognize them, at least not that first time. It was the high-heeled shoes, I guess. But when they stopped outside my door, I heard my mother’s voice, “You say she had a good night?”

Then I heard another voice which belonged to the big yellow nurse. “Her chart says, ‘quiet as a lamb,’ Mrs. Redfern.”

“Really? Oh, Miss Watt, such a nightmare I’ve been through! Hardly slept a wink with the worry and the doctor not phoning until very early this morning. And still no firm diagnosis. But what a shock this is – pediatric isolation. “

“Its a simple precaution, Mrs. Redfern. Until the test results are delivered.”

“They think it’s catching don’t they?”

“Now don’t fuss yourself, Mrs. Redfern. It’s good practice to err on the side of caution. Dr. Hannah is like that. Very conscientious.”

“I’m at risk, aren’t I? You can tell me.”

“I hardly think so, Mrs. Redfern. Please don’t fuss. But look, Alice has opened her eyes. This is good. Let’s see if she’ll talk. Hello Alice, how’s our girl?”

My mother walked across the room to my bed, her high heels making her legs look pretty and her ankles so small. Her skirt made a soft swishing sound. She was all dressed up as if she were going to a party with my father, in her navy-blue outfit and her bracelet which dangled gold coins from a faraway country.

“Here you are, dear Alice. I thought I’d never be able to find you. The silly people downstairs told me you were in 2 West but here you are in 2 East. I was wandering down the wrong hall when Miss Watt rescued me and brought me here, Room 2-57. But I don’t suppose that number makes any sense to you. Not now anyway. I mean how could it? I don’t suppose you remember this nice nurse, Miss Watt, either.”

l remembered her yellow eyes and her fatness squishing me into the hard table before the needle went in.

Mom leaned over to kiss my cheek. The bristly hair on her upper lip brushed my skin. Softly. “Qu’as-tu, mon enfant?” Mom always spoke French because she liked the way it sounded. “A beautiful language” is what she always said. When I didn’t answer she spoke again. ‘Qu’as-tu, mon enfant? “

Her eyes moved in close, as if looking for something. Mom’s eyes were small and flat. Inside, they were dark so I couldn’t see their colour. Inside Sarah’s eyes there are lights that dance, friendly, so I want to go inside too.

Watt left after writing on a chart that hung on the end of my bed.

Mom moved the chair closer to my bed, sat down and pulled a wide box out from her handbag. The box was wrapped up as if it were brand new.

“A gift for you, Alice dear. Just for you,” She placed the box on top of my legs. “Go ahead, you don’t have to wait. Open it now.”

I pulled at the wrapping, trying hard to bend my rubbery fingers the right way. Mom watched, sitting on the edge of her chair, her top lip curled up so I could see the tips of her teeth. When finally I tore open the wrapping I found two rows of plastic figures fixed neatly in a box. The top row of figures was cowboys and the bottom row was Indians.

“I shopped at the Maza on my way here. They’re for your hospital stay. To play with here, on your bed. “

Cowboys and Indians are for playing outside.

“Now Alice! What’s the blank face about? Please. Come along, you don’t have to wait to take them out.”

And so I pulled out the small, beige figures, twelve on top and twelve on the bottom. There were two kinds of cowboys; one holding guns at the end of outstretched arms, the others holding lasso ropes at their waists. There were two types of Indians as well. One had bows and arrows while the other had tomahawks held high above their heads.

“Thank you, Mummy.” I started to put the figures in rows on my bed but a numbness crept inside my arms, my legs.

“You’ll have a wonderful time with them, dear. You’ll see. I know how you’re always wanting to play Cowboys and Indians at home. This way you can play without ever leaving the bed.”

My eyelids kept falling closed. I fell back on my pillow.

“Good girl Alice, dear. Sleep, sleep. It’s what’s best for you. “

For a long time I didn’t hear any sounds inside the room. I drifted in and out of listening for Sarah’s feet coming down the hall- but mostly I felt heaviness. Later when my eyes fell open a little bit and Mom was still on the chair beside me, her head leaning on her hand, I asked carefully, just in case she might be sleeping.

“Mummy, Sarah said that maybe her Bugs Bunny could come. That she would let him stay with me. My bed is big enough, you see, don’t you?”

“Oh my! I nearly forgot.” She leaned over and grabbed the large bag on the floor beside her. My stomach tightened and I took a deep breath. Any moment Bugs would be on my bed nestled in beside me, full of all Sarah’s smells and the smell of her bed, too.

The sound of rustling filled the room as my mother stood and pulled a long stiff paper roll out from her bag. She lifted her arms over her head and began to unroll the brown paper slowly. The paper was painted on the side facing me. As she unrolled, long grey and white rabbit feet appeared, then legs, then a white gloved hand at the end of an outstretched arm. In the hand was a bright orange carrot. She unrolled some more. Two huge white teeth appeared, then a familiar rabbit face, its cheeks, big and puffy. The face was grinning.The unrolling finished with pointy grey and pink ears standing straight up.

My mother’s face poked out from behind, her arms still high above her head. Both rows of her teeth were showing, like Pepper, the dog next door when I charge him with my scary monster face and make him growl. “Isn’t he wonderful, Alice, dear? Sarah got him all, don’t you think? Even his cheeky grin. And the carrot. She worked all last night-drawing, painting. Just for you! She was still up and painting away, when we arrived home after leaving you here. It was after midnight, long after she should have been in bed. Of course there was paint all over the kitchen. On the table. On the floor. I told her she had to go to bed, but oh no, not our Sarah, she had to make him just right. Just for you!”

He wasn’t Bugs. Not really.

“But why are you crying, child? There, there. You must stop, right now. Be a good girl. You’ve nothing to cry about. Don’t you understand? That silly stuffed animal was absolutely filthy. They never would have let him stay. Dr. Hannah said so, of course. And we must do as he says, you know that, dear, if you want to get better. If you want to leave this room. Now brighten up. I’ll go ask Miss Watt if we can hang your new Bugs right here, at the end of your bed.”

My eyelids fell closed. Later, when they opened, the chair beside my bed was empty. The paper rabbit hung on the wall at the foot of my bed, covering the long line of the crack that my eyes were traveling before Mom arrived. The plastic figurines were lined up on my food table; the two kinds of cowboys in one row, the Indians in another. Mom had left. The room was full of footstep sounds, thick in the hall and inside my room. They traveled through my closed, white door, up the walls, down the windows, into my head. In and out. But I didn’t recognize any of them.

Emerson Regional Hospital

PATIENT NOTES

Name: Alice Redfern
Family Physician: William Hannah MD
Date: 16.04.96

Lab Results

CSF: Abnormal with lymphocytic pleocytosis indicating viral infection of the Central Nervous System.

Physical Exam.

7:34
Temp: 101F.
BP. 110/70 mm.hg.
Iris Watt RN.

Comments

7:56 Headache ameliorating post lumbar puncture. Some sensory loss, moderately flaccid limbs with suspicion of mild paresis in fingers and toes. Continuing rigidity in neck and back. Moderate light sensitivity. Continuing disorientation, apparent forgetfulness. Still does not recognize me and not responsive to questioning. Compliant during exam.

RX. to RN.s : Engage patient in conversation as much as possible.

William Hannah MD

10: 43 Still sleeping heavily. No desire to be awakened or ambulatory. Flaccid limbs. No interest in food. Suspect continuing nausea but no vomiting. Compliant with liquid meds. No verbal response to questions but once nodded head in response. Closes eyes when spoken to, as if falling asleep. Suspect disorientation. Still no personal items for her room. No interest in doll or book which I borrowed from playroom. Poor hand agility.
Iris Watt RN

15:47 Displays minimal response to mother’s arrival. Mother jittery and anxious about contagion. Very stiff in her contact with child. Brings no personal item but offers unusual gift. Surprised by my suggestion to bring family photos and favorite story books. Questions A’s ability to understand stories. Asks if she’ll be a “half-wit”.
Iris Watt RN
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