from "Crisis Response Simulation"

On the tenth Saturday of Advanced First Aid for Parents, the class was divided into two groups for a crisis response simulation. McKay, the retired ambulance driver who taught the course, had explained that all the careful study and review in the world didn’t amount to much if you couldn’t react in a real emergency. Tommy falls off his bike and cracks his kneecap. Are you going to take the time to consult your handbook? A fire ant bites Suzy while you’re visiting Centre Island for the day and her left foot is swelling to twice its size and she can’t even fit it back into her sandal. Are you going to pull out your cellphone and call 911? You’re visiting Wonderland and Suzy and Tommy stick their arms outside of the car on the one of those insidious roller coasters and you can hear the bones crack from where you’re waiting at the ride’s exit. Are you going to wait for the park’s medics to arrive and save the day? No, of course not. What was important, according to McKay, was the ability wrap a bandage immediately. The capacity to apply heat or cold without hesitation. The presence of mind to turn a tree branch into an effective splint.

At bed on Saturday nights, Isaac had imitated McKay for his wife Hannah, creating scenarios in which the fictional Suzy and Tommy suffered from malaria or scurvy. Or they were attacked by a wolverine while cutting through the woods on the way home from school. And the couple had both laughed. But now while they waited on the stairs for the simulation to begin, Isaac noticed how his wife’s knee was bouncing up and down. They were sitting outside the boys’ gymnasium in W.E. Thompson secondary; the lessons were usually in one of the school’s empty classrooms, but today, as McKay had explained, they would need the open space of the empty basketball court. Like two-thirds of the couples in the class, Isaac and Hannah were to play the role of rescuer. The other third were patients, and McKay had already taken them into the gym to review their performances and apply cosmetic bruises, contusions, and lacerations. The injuries would look surprisingly real, he’d warned the rescuers, so be sure to keep your head about you.

Hannah turned to her husband.

“Acts?” she said.

It was McKay’s acronym for assess, control, treat, and seek. Assess the damage. Control the situation to prevent further damage. Treat escalating damage. And seek medical professionals. ACTS. During the duller moments in class, Isaac had created his own emergency short forms in the margins of his first aid handbook. The best he’d come up with was OOPS. Observe, overreact, panic, and sob.

It wasn’t that he hadn’t taken the class seriously. In fact, he’d suggested it to Hannah when they’d decided to start trying for kids. And he’d taken careful notes all through Eye Injuries, Nosebleeds, Cuts and Scrapes, Burns, and Tooth Accidents. But during the sixth week, during Objects Lodged in Ear or Nose, Isaac started to wonder less about childhood injuries and more about adolescent and adult wounds. How would he help Tommy decide upon a college major? How would he teach Tommy to have a high self-esteem? How could he possibly deal with Suzy’s first broken heart?

The couple had first delayed children because Hannah was in graduate school. They’d lived well enough on what Isaac made at the sales firm, but once she graduated, they figured they’d be able to put together a good nest egg quite quickly. Hannah didn’t find work until a year after school, though, and by then it made no sense to have kids right away. Better to wait until she was established at the Revenue Canada branch. So they’d have enough to make the increased mortgage payments on the new house and she’d have a secure position to go back to after the maternity leave. Waiting had made sense, but as she approached thirty and he approached thirty-four, they decided it was time. They wanted to have the kids out of the house by the time they retired, after all. And then there was the worry of aging ovaries.

In bed the night before the simulation, Hannah had quizzed Isaac on Brain Injuries. If they were going to start worrying about brain injuries, he said, they might as well consider impaling and juvenile diabetes. Or why stop there? Maybe what they should really be concerned with was birth defects. Mongoloids and flipper babies. They weren’t even pregnant yet, he reminded her, so perhaps they could slow down on the worrying.

“What if we get a really serious case?” Hannah asked him now.

Isaac wanted to redirect her thoughts and so he asked her if she’d ever noticed how all high schools look vaguely the same. Painted brick hallways and slate floors that echoed if you were staying late after school for band practice or play rehearsal. And yet, the high school, if you return to the high school you actually attended–for a nostalgic stroll or a ten-year reunion–would immediately remind you of nothing else but grades nine through thirteen.

“Yes. You told me that a few weeks ago,” she said.

When they first married, she didn’t call attention to his repeated anecdotes, but this change was natural, he thought. Maybe parenting would be like that. Maybe what first seems crucial and important might grow commonplace over time. They would fasten Tommy and Suzy’s first report cards to the refrigerator door, but they couldn’t possibly post every report card from every semester through elementary school and high school. And Isaac knew that at first he’d remind Tommy and Suzy how beautiful and smart they were as often as he could, but it was possible that these compliments would grow hollow through repetition and he might stop encouraging them at all.

“We won’t get a serious case, love,” he said.

Isaac was about to pat her knee, but remembered she found this gesture condescending. The last time he’d patted her knee, they’d gotten into an argument that lasted two hours, until he apologized. Afterwards, he’d pointed out that they never really had arguments; their arguments, he said, consisted largely of some stupid remark on his part, which would be followed by sulking and a series of apologies two hours later. And in truth, no matter how careful he tried to be, he did make stupid remarks. Once when they first moved in together, he admitted to her that he preferred to do the weekend crossword alone because she simply didn’t contribute much. And another time he told her he’d never wear the three pairs of socks she’d bought him because they rode too low on his ankles and she might as well have thrown away the five dollars. Still, he thought, a handful of petty or selfish remarks over eight years of marriage didn’t make him a bad husband.

After they’d gotten engaged, they moved into a one-bedroom apartment underneath an older couple that fought constantly. Night after night, the couple upstairs yelled insults at one another, and Isaac and Hannah made an agreement they’d never be like that. They would never use those kinds of words against each other, and they would never even think them. Sometimes, the sound of urgent running came through the ceiling and they didn’t know what to do. Accompanied by yelling, these footsteps could have meant violence. Hannah wouldn’t let him go upstairs. You don’t know what kind of people we’re dealing with, she’d said. One night, when Isaac thought he heard the wife yell something about a hurt lip, he phoned the police. Hannah sat beside him at the kitchen table while he gave his name and phone number to the police and agreed–if need be–he would testify in court. Afterwards, Hannah told him he was a good man.

That was years ago, Isaac thought, but maybe she still believed it. He was about to ask her when McKay kicked open the heavy metal doors of the gymnasium.

“You have fifteen minutes to find your child and take care of their injuries. ACTS, people, ACTS.”

The ten couples each grabbed their first aid kits and hurried into the basketball court. Isaac followed Hannah as she circled the court looking for Christine, the only single parent in the class and their assigned Suzy for the day.

“Tommy and Suzy need your help,” McKay yelled.

On one of the three-point lines, there was a Tommy with two scraped knees and a headache from riding his bicycle without a helmet. Close by on the free-throw line, Suzy complained of a sore tummy caused from drinking cleanser underneath the kitchen sink. In the center circle, another Suzy had a wooden stick lodged in her throat, the result of running with a Popsicle in her mouth. None of these children were Isaac and Hannah’s Suzy, though, and the couple continued running across the hardwood floor.

“If you can’t take care of your children,” McKay yelled, “Children’s Services will take your children away.”

He was only trying to increase their stress, Isaac reminded himself. On the sideline, another couple found their Tommy, who was complaining of discomfort after inserting a pea in his nose. Turning away, Isaac momentarily lost Hannah but heard her call out. She’d located their Suzy at the far end of the court, underneath the away team’s net. By the time Isaac got there, Hannah was already kneeling down beside the child, trying to assess the damage.

“Show Mommy where you hurt yourself,” she said.

Suzy was curled up and screaming, and even when Isaac kneeled down beside his wife, Suzy wouldn’t say what was wrong. Shaking her head and screaming, she refused to show the couple her injury. Would a real child act like this? Isaac wondered.

“It’s all right, honey.” Hannah stroked Suzy’s forehead. “But we can’t help you if we don’t know what’s wrong.” Their Suzy continued to scream and shake her head, and Isaac had to admire just how convincingly Christine was committing herself to the role of patient.

Behind him, Isaac heard McKay congratulating another couple. It was the bicycle Tommy and his parents. Apparently, they had already disinfected their son’s knees and had announced that they wouldn’t let him sleep in case of a concussion. Another couple yelled that they had successfully controlled their situation and were preventing further damage. Although their Suzy hadn’t stopped screaming, stoking her forehead worked, and she held out her hand for Hannah and Isaac to see. Driven into her right hand, between the thumb and index finger, a thin metal spike tore into the flesh and prodded through to the palm.

“Jesus,” Isaac said.

Hannah was crying and fumbling with the latch on the first aid kit. Taking her hands in his, Isaac stopped her shaking and together they opened the kit. The disinfectant pads were supposed to be underneath the gauze, but they weren’t. Hannah grabbed onto the two sides of the kit and shook it until the entire contents fell onto the hardwood floor in a pile of handbook, gauze pads, packets of burn salve, tensor bandages, cloth, and band-aids.

“Get her to sit up,” Hannah directed her husband.

Holding Suzy by the shoulder, Isaac reassured her that everything would be fine. Once she was sitting up, he grabbed her by the wrist and held the injured hand up. Any penetration of the skin should be held above the heart to slow down bleeding. Looking more closely at the injury now, Isaac tried to work out how the prop had been attached to Christine’s hand, but at that moment, the spike still looked like a spike and the blood still looked like blood.

“Have you found the disinfectant?” he asked his wife. Hannah was crying more now; she said she’d looked through the first aid supplies twice but the pads just didn’t seem to be there. She’d double-checked the contents of the kit last night and it made no sense at all. Across the basketball court, other Tommys and Suzys were standing up and McKay congratulated the successful rescuers.

“You are now reaching the critical time,” he yelled, “after which your child might suffer permanent damage.”

How many minutes had passed already? Isaac wondered.

“Acts,” Hannah repeated. “Acts, acts, acts.”

This was how she approached everything. Her work, paying bills, cleaning the house were all approached in a systematic fashion that Isaac admired and followed. While in their first apartment, they’d saved enough for a down payment on a condominium in a neighborhood she’d recommended, and after one short year, they managed to sell the condo for a profit and put a down payment on a townhouse. And just before the market went down, they’d sold the townhouse and moved easily into a detached three-bedroom house in a new subdivision. Why wouldn’t Isaac follow her lead? Suzy continued to scream. Stroking her forehead, Isaac didn’t know what to say to reassure her.

“You’re smart,” he said. “You’re beautiful. And Mommy and Daddy love you very much.”

Giving up on the pile of gauze, bandages, and band-aids, Hannah returned to the first aid kit itself. An Epee pen was attached to the inside wall of the case and the disinfectant pad had lodged itself in behind. Okay, okay, okay, she repeated. Isaac watched as she tore open the packet with her teeth and unfolded the disinfectant wipe.

By now, McKay was standing over them with a small group of successful rescuers.

“You’re not helping anyone,” he yelled, “if you become flustered and lose control of the situation.”

Isaac held their Suzy’s hand steady while Hannah wiped away the excess blood around the metal spike.

“The greatest danger in a penetrating accident like this,” McKay barked, “is infection to the bone and the surrounding tissue. Wiping around the flesh will not be effective.”

Hannah looked at Isaac for help, but he didn’t know what to do next either. He was about to shrug, but then worried what response this might provoke from McKay. Perhaps, he suggested, it was best to remove the spike and wrap the entire hand tightly in gauze.

“Any attempt to remove the foreign object in a penetrating injury might result in permanent damage to the flexor tendon sheath,” McKay pointed out. “The hand will no longer be able to perform complex digit movements.”

Hannah retrieved the handbook and flipped to the index. Under “hand,” she found “broken fingers” and “crushing accidents” but no mention of metal spikes.

“Try ‘p,’” Isaac suggested, “for ‘penetration’ or ‘penetrating wounds.’”

While she flipped through the pages, Isaac told their daughter she was smart and beautiful once again.

“Time’s up,” McKay yelled. By now all of the other students in the class were gathered around them. “Suzy has suffered irreversible injury to her hand. She will no longer be able to change the clothes on her Barbie dolls and she will have trouble manipulating even a simple knife and fork.”

Their Suzy stopped screaming and Hannah wiped her eyes with the back of her hand. But a metal spike in the hand wasn’t a pea up the nose, Isaac thought. The crisis response simulation was rigged.

“Hannah and Isaac,” McKay explained, “decided to take Suzy on a weekend camping trip outside of the Ottawa Valley. While putting up the tent in which they would stay up late and tell harmless ghost stories, Suzy accidentally drove the tent peg through her hand. Her parents weren’t ready and didn’t know what to do.”

No longer in the role of Suzy, Christine stood and listened closely while McKay reviewed the correct procedures to follow when faced with a penetrating injury to the hand. Sniffling, Hannah gathered together the spilled contents of the first aid kit, but Isaac still didn’t move. He couldn’t seem to pull himself up off the floor of the basketball court.