A Mountain To Climb Chapter 11: A Puzzled Doctor

A better title for this chapter would be “An Incompetent Doctor.” Because for me this chapter was the strangest part of the book. I googled the shit out of the events in this chapter. Can I explain them? No. I don’t believe I have all the details and what details we do have are likely lost to the mists of time. Remember, at least 3o years passed between the events of this story and the time they got written down. And so, while I do not believe that Pearl Lindsay or Eva Maxson intentionally lied about anything, I’m gonna go out on a limb here and say that they probably missed one or 5 critical details.

With that in mind, let us begin.

We last left off with the doctor just about to operate right as Arthur and his pals decide that God has told then he is totally going to save Pearl’s leg. Just as this happens, the intern realizes he can’t find Peal’s pulse. Has Pearl passed out? Did she die? Can you be alive with no pulse?

While 6 young men on a hillside had felt assured that their prayers were heard, the face of a young intern in the Port of Spain hospital was red with embarrassment. He couldn’t do such a simple thing as find a pulse, and in front of a specialist!

If you can’t find the pulse I would be worried about more than just minor embarrassment. Is Pearl dead?

I’ve already talked about who I think this specialist might be. It seems he was very good at his job. I’m going to be generous and assume that this is early on in his medical career….

“Here, let me try,” Dr. Pierre said, almost impatiently. But he couldn’t find it either. “Are you scared, Pearl?” He asked.

“No-o, not much.”

Wait a second…..Pearl is alive? And conscious?

As he continued to probe for her pulse, the doctor noted that her breathing was almost normal. He glanced at the clock. It was eleven o’clock, time for the operation to begin. Finally he motioned for the other doctors to follow him into another room.

“I can’t operate,” he told them. “Without any heartbeat, if I put a knife on her she’d die at once. We’ll just have to wait. If we can’t locate the pulse soon, we’ll have to send her back to her room.

Hang on….  Pearl is breathing but has no heartbeat? How exactly would she die the minute you put a knife to her? Lack of heart beat is kind of the definition of death at this point in the 1930s. How could she get any more dead?

But Pearl is not dead. Pearl is very much alive. She is still breathing, and we are not told if she is showing signs of oxygen deprivation, but I’m gonna go ahead and assume her airway, breathing, and circulation are normal.

So, what’s going on here? Pearl is breathing but has no pulse or heartbeat, she’s alive and conscious and aware of her surroundings. How is this possible?

It’s not. If Pearl is alive, Pearl has a pulse. I have googled the shit out of this. I think it’s possible for someone who is unconscious to lack a pulse but still be alive enough to resuscitate, but anyone who is alive, talking, and aware of her surroundings has a pulse. And a heartbeat. If Pearl is breathing, Pearl’s heart is beating. That’s kind of how our bodies work.

Why can’t the doctor find it? Here are a few ideas, but these are merely speculation. Neither I nor S have been able to find out anything by googling. This, by the way, is the extent of the conversation S (who donated the book) and I have had about this book. We wanted to do separate reviews to see if we arrived at the same conclusions independently, but we did talk about this because they have some medical knowledge and I wanted their opinion.

First, if they are only checking her wrist, that could be a problem. The pulse can actually be felt at various points all over the body, including the neck. In EMT school I was taught that if you couldn’t find someone’s pulse by checking their wrist or thigh, you should go for the jugular. There are a number of things that could obstruct blood flow the limbs, but the pulse would always be in the neck.

Pearl has been through various surgeries to try and stop the spread of infection. That’s gonna be hard on a person’s body. We were also told a few chapters ago that she has been given a medication that makes her sleepy, which could be slowing down the heart rate. Also, one of the nurses tucked a blanket around her before wheeling her down the hall. If that blanket was bunched up under the armpit, that could cause the wrist pulse to feel weak or non existent.

The doctor asks if Pearl is afraid, and she says she kind of isn’t. I would think that fear would increase the heart rate, not decrease it. I wonder if Pearl could have been given something for anxiety, and if that could also be a contributing factor in slowing down the heart rate/pulse?

It is not stated whether or not the doctor checks the neck pulse.

Dr. Pierre walked slowly back to the operating table. Again he searched for the pulse, then he used his stethoscope, but in vain.

One thing S did bring up that I hadn’t thought of is the quality of the tools Dr. Pierre had to work with.  Are stethoscopes in the 21st century the same as stethoscopes in the 1930s? Neither of us has been able to find out anything about it.

I am convinced that if Pearl lived in the 21st century and was hooked up to one of our machines, they’d find her damn pulse/heart rate. But Dr. Pierre did not have such machines at his disposal. However, a nurse friend has told me that sometimes you have to use your common sense. If, for example, the monitor says the patient’s oxygen level is fine but the patient is turning blue, you need to use your goddamn brain and decide that something is probably wrong with the machine.

I would assume the same thing here. The problem is not that Pearl has no heartbeat or pulse, the problem is that you and your dumb stethoscope can’t find it.

The doctor tells Pearl that he can’t operate until he can find the pulse, and that they’ll have to postpone the operation.

Do I agree  with this decision? I’m not sure. I’m not a doctor, and would love to have someone more knowledgeable weigh in on this.

Pearl is disappointed. She was so looking forward to being cured, and now she won’t be. The doctor says they will wait,  but after 5 minutes, there is still no pulse.

Doctor Pierre is baffled.

“Why are all her other systems functioning and not the circulatory? I have never seen anything like this.”

Her circulatory system is functioning you asshole.  She. Is. BREATHING. She is showing no signs of oxygen deprivation. Clearly her circulatory system is functioning. What you actually mean is that you think her heart isn’t beating. Even if I do allow you to believe that, that would mean that her heart isn’t working. The rest of her circulatory system is functioning normally.

The doctor decides to send Pearl back to her room. He’s not comfortable performing the operation if they can’t find the pulse. Which is kind of fair, that is an important thing you’d want to monitor if you’re performing surgery.

The doctor tells the teacher, Mrs. H, what’s happening. Mrs. H tells the doctor about the pray-a-thon the students are having and she is sure that God had a hand in this.

“I don’t know your God,” he said, “but I do know that what is happening in that girl’s body is impossible.”

So why aren’t you looking for a scientific explanation? If what you see is impossible, you don’t just throw up your hands and talk about it. This hospital is equipped with an X-ray machine. Why the hell aren’t they whisking Pearl down to the X-ray room for some tests? I’m not sure if you could get an X-ray on the heart, but I do know that you can get them done on lungs. If her lungs are working, there’s her circulatory system functioning.

As the teachers are talking with her, one of them tells Pearl that she believes this is a sign from God that He will heal her leg. Otherwise, why would all this have happened?

Oh really. If he was going to do that, why wait till the last minute? And why do it in such a way that leaves room for doubt? If I were God and I wanted to do an obvious miracle, I would, say, cause the doctor’s surgical instruments to vanish the minute he goes to use them on Pearl. OH MY GOD I WAS HOLDING MY SCALPEL 10 SECONDS AGO WHERE IS IT? This would then happen with every single surgical instrument that is allowed to get within 3 feet of Pearl.

Or I’d  like, I dunno, cause the leg to heal instantaneously right in front of the doctor.

Or I’d just send a goddamn angel to appear to everyone (not just the doctor) and be like, “The Lord says not to perform the surgery. Put down the knife and step away from the victim.”

At the very least, if I were God and wanted to send the doctors a sign that would stop them from performing the operation and for some reason didn’t want to just send an angel to tell them that, I would add “Pearl is not breathing but still surviving just fine” to list of symptoms. By JUST taking away her pulse/heartbeat, God made it clear as mud.  Really, if this doctor were halfway competent he would be running some tests.

“The doctors can’t understand it either,” Mrs. Hamilton said. She laid her hand on Pearl’s wrist, unconsciously feeling for the pulse. “Why–why,” she muttered to herself. “I feel a pulse beat!”

So, Pearl was “without” a pulse or heartbeat for what sounds like a little over 5 10 minutes. Yet all of a sudden Pearl’s teacher was able to find it. Why?

Well, I suggest the Blanket Theory. Remember how Pearl had a blanket tucked around her on her way to the OR? Perhaps part of the blanket was bunched up tight under her armpit, and combined with the drugs that made her sleepy, the shock of the previous surgeries, and some of the blood loss that would have come with that, it made the pulse in her wrist near impossible to detect.

Then, after coming back to her room, the blanket somehow got dislodged, freeing up the blood flow to the wrist. Or perhaps by then some of the sleepy drugs had had time to work their way out of her system.

Pearl tells the nurse that she is in a lot of pain. The nurse gives her something to “make her sleep.” Which seems like it would be a bad idea if they are worried about her pulse. But Pearl is unable to sleep.

If God’s hand were in this, why wasn’t she completely healed? What about the weeks and months ahead? Would the pain ever stop? Would she really walk again?

A damn good question. If I were still a Christian I would have to go through some sort of mental gymnastics to talk about why. I mean, when Jesus healed people in the New Testament it was usually pretty instantaneous.

Now, the doctor hasn’t quite said that he won’t perform the surgery now. So I don’t know why they don’t just whisk her right back down to the OR to operate. Mrs. Smith even tells Pearl that if God hadn’t interfered, she’d be “minus a leg now and that would be for keeps.” She gushes at Pearl, telling her God must have something wonderful in mind.

A nice plot twist would be if the specialist comes back and tells Pearl it’s time to operate now.

The chapter ends with Pearl asking what time it is, and being told it is 3:30.

Is the doctor just not going to operate, then? Has he decided that the only explanation has to be “miracle from God?” Is he just going to wait and see if He heals Pearl?

Here’s the problem I have with that approach. They were going to take Pearl’s leg off for a reason. Because they were faced with a horrible choice: cut off the leg, or let the infection spread to the rest of her body and kill her. The longer they wait to operate, the more time there is for the infection to spread. Now, maybe it wouldn’t spread that quickly. Maybe you could wait another 2-5 hours. But you wouldn’t want to take the “let’s wait a few days and see if God performs a miracle,” approach here.

Because that sort of thing could be deadly.

And so, even though (spoiler alert) everything turns out ok in the end,* and while I am very glad that Real!Pearl got better and didn’t lose her leg, I still think the doctor made the wrong call. He had no way of knowing in advance what would happen, and his hesitation could have killed her.
Here’s the other thing: we are only hearing about this story because, obviously, Pearl does get better. How many other stories are just like this but don’t have a happy ending? How many people has exactly this sort of hesitation killed?
We can’t know. I am hoping the number is “zero,” but I doubt it.

Next week: Will Pearl be healed? How long does that take? Will Arthur be a bit of an asshole to the receptionist? Does Pearl have problems with one of the nurses because the nurse is a bitch, or because Pearl is uncooperative?

 

*I was trying to keep you all in suspense for a while, but seriously, if there wasn’t a happy ending here, this wouldn’t be a book.

 

 

 

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