The decision to operate

On March 1, Odim reviewed the heart catheterization report. In a letter to Giddins, Odim described Jessica as having a minimally restrictive ventricular septal defect, with elevated-end diastolic ventricular pressures (one of the earliest signs of the heart's failing as a pump), and with no evidence of significant ventricular outflow tract obstruction. He wrote, "This ventricular septal defect clearly will not close on its own." (Exhibit 13, page ULI 9)

In a separate letter to Giddins, Odim described meeting Jessica and Emalee Ulimaumi with an interpreter on March 1. He wrote, "I explained to the mother, via the interpreter, the importance of surgical repair of this ventricular septal defect. The mother appeared to understand the necessity for this intervention as well as the risks. We should plan to bring Jessica back within the next four to six weeks in order to repair this lesion. Hopefully by then she might have gained some additional weight." (Exhibit 13, page ULI 10)

On March 18, Jessica was admitted to the Churchill Health Centre with nausea, vomiting, fever and diarrhea. A chest X-ray showed no signs of congestive heart failure. She was diagnosed as having gastroenteritis and continued to have diarrhea after discharge. Dr. Smith, in Churchill, spoke with Giddins about Jessica's condition and arrangements were made for Jessica to be admitted to HSC on March 23 in preparation for surgery.