Sunday, August 28, 2005

ER ADMITS

One of my favorite things to do from time to time is to check the list of ER admittees and see what their presenting complaint was when they walk in. They run the gamut from the tragic to the ridiculous. There's the prosaic: cut finger, high creatine count, fell down escalators, neck pain, severe cramping, the omnipresent chest pains (or CP), the omnipresent shortness of breath (or SOB [an acronym, I might add, that caused me no small amount of confusion until I figured it out]), toenail injury, medical evaluation due to chemical exposure, "might be danger to others," migraine. There's the tragic, the more severe the condition the more terse the description: MVC (motor vehicle collision), GSW (gun shot wound), or simply 'trauma.'

Then there are the ones we chaplains like: the ridiculous ones. Somebody walks in, the secretary or charge nurse asks them what the problem is, and they reply, and their reply, sometimes verbatim, sometimes subject to the staffer's interpretation is inscribed in the hospital database forever. These ones are, well, creative: fell on butt, bit by badger, someone named "stryder aragorn" complaining of mental status changes, insect bites, 'anxious,' cat bite, anxiety, testicular discomfort, and--since we're in that vein--my personal all-time favorite, "my stuff is messed up." Finally, of course, there's the catch-all: 'I feel bad." Ladies and gentlemen, human ingenuity.

Monday, August 15, 2005

SICK BAY (pt ii)

She has no arms, and she has no legs. It’s an awful, awful story.

26, married, just had a new baby. Walking through her backyard in California one day and steps on a rusty, sharp piece of metal. Does bad things to her foot. Does worse things to her blood, which becomes infected. She goes to see the doctor; the doctor says to go to the hospital. She gets worse, then she gets a lot worse. In the end she gets a severe blood infection, which necessitates amputating all four of her limbs—the arms just below the elbow, both legs just above the knees. She’s in Chicago for a tour of duty at our rehab hospital, which has the rep of being the best in the country.

It’s so awful you can’t really take it in. I had a conversation with her nurse one day in the hallway, and I struggled to find the words to describe it: “I can’t believe it….my jaw just hits the floor. I don’t know how she’s finding….I mean, I don’t know how she gets up in the morning.” Her flinty reply: “I’d rather be dead.”

She’s focused on her kids right now. It’s something you see in the hospital: how strong the parenting instinct is, how often people cling to life for the sake of their children. Whatever grief or despair or shock or rage or bewilderment troubles this patient’s spirit, she’s pushed it away to the far recesses, locked it in some closet somewhere to be visited at a time when her 7-year old and her 4-month old aren’t living with their grandparents in Fresno. Some time when their mother can actually mother them.

I admire her. But here, again, the stunning reality of what’s happened to her. How can she mother now? Imagine it. How do you breast-feed your child with no hands? How do you diaper, dress, groom, bathe, cook? How do you run your hands through their hair, whisper reassurances in their ears when they skin their knees or fall off their bikes? How do you pick them up from school? Sign their report cards? Spank them?

She has to learn how to do everything again. She might as well be an infant. The formidable people at the rehab hospital will do their best—and their best, I know, is damn good. But from now on, she and her family bear two burdens: first, the burden of the simple awfulness of what has happened to her. Second, the burden of trying to learn to live with no limbs.

Her husband is around all the time. I wonder why at first and then realize it’s because he has to do absolutely everything for her. Her turns her to face me when I come in the room. He’s probably the one who’s shaving her armpits or shampooing her delicate hair. He’s doing it all. It’s too big. It’s too big. I keep slipping—I try my best, but I can’t help it. I talk about ‘getting a foot in the door.’ I offer to bring her and her husband some cards to pass the time. I bring her a Bible and then wonder how she’ll read it to herself.

She’s got a beautiful face, and I imagine she must have been quite a catch back in the day. But now she’s not the woman her husband married. Nobody’s wants to ask the $64,000 question—can they still have sex, and is he still attracted to her enough to do so?—but it’s in the air.

I keep looking at her husband and wondering: OK, what are you thinking, buddy?

I keep looking at her husband. Big, beefy guy. His UNLV t-shirt and jocky demeanor give me the impression of a guy who’s spent some quality time standing around a keg. His wife welcomes me, prays with me. He’s a bit more standoffish; sometimes he prays, sometimes he watches ESPN, sometimes he naps. At first I’m a tiny bit off-put. But after a couple days of his quiet presence, I start to warm up to him. He might be a bit sullen or out of it, but dammit, he’s here.

I read an interview—it was with Morton Kondracke, of all people, and whatever you think of his politics it's a great read-—where he discussed how husbands respond when their wives are diagnosed with Parkinson's. Once it becomes clear that at some point down the road—decades hopefully, years possibly—that their wife will no longer be able to care for herself or perform ordinary daily activities, a huge proportion of them split. Half, to be exact. Just left their wives. Said “screw this, this wasn’t what I signed on for.” 50%? It's a number high enough to make you believe in original sin.

Is some part of him, way down deep or right under the surface, thinking: I cannot do this. I cannot do this. I want to find some way to find out what he’s feeling and give him a big hug and tell him how awful this is and that God’s going to help them both get through this and help him do the right thing. But there’s no access point, no way to get in touch with that side of him. Maybe he’s a stand-up guy, and those feelings aren’t there at all. Or maybe they are—the flip-side of what his wife is going through—and he simply can’t spend any time with them yet, because his wife needs to be turned, or helped to go to the bathroom, or to sign her own name.

I don’t know how to pray with them. One of my fellow chaplains—a man who never wants for a long, lengthy, beautiful prayer—went to go see her the other day and was stunned into silence. He stood there, dumbfounded, for a long while before he could think of what to pray. Which is probably for the best—better to bow in reverence before the awfulness of this, the awe-fullness of this, than to fill a holy and redemptive silence with shallow words, easy words, dumb words. They don’t need those, and they don’t have time for those.

So I don’t lift up the grief, I don’t lift up the healing. I don’t say, “Dear God, show us how to go on in the face of something this horrible.” Those feelings are either on hold for a while, or I don’t get to see them—and in either case I understand. Instead we pray for the small things: that she’d get her heart murmur taken care of so she can go back to the rehab hospital. That her pain would go away. That she’d complete her rehab tour of duty in time to go back with her husband to California by the end of this month like she’d planned. That their children would be alright. I give them a Bible and tell them I’ll see them tomorrow.

She is wearing her wedding ring, on a chain, around her neck. I am praying for them.

Sunday, August 14, 2005

"PONDER NOTHING EARTHLY-MINDED"

From the "songs stuck in my head during on-call department":

Let all mortal flesh keep silence, and with fear and trembling stand
Ponder nothing earthly-minded, for with blessing in his hand
Christ our God to earth descendeth, our full homage to demand.

King of kings, yet born of Mary, as of old on earth he stood
Lord of lords in human vesture, in the body and the blood
He will give to all the faithful his own self for heav'nly food.

Rank on rank the host of heaven spreads it vanguard on the way
As the Light of light descending, from the realms of endless day,
Comes the powers of hell to vanquish, as the darkness clears away.

At his feet the six-winged seraph, cherubim with sleepless eye
Veil their faces to the presence, as with ceaseless voice they cry:
Alleluia! Alleluia! Alleluia, Lord most high!

ACTUAL VOICE MAIL FROM A.Y.T.

"Dave, it's Dan. If you're trying to fool me into thinking that you have a social life by not answering your phone, it's not working. Gimme a call." (After I missed two of his phone calls this weekend.)

Monday, August 01, 2005

THE BACKSTROKE OF THE WEST

Do you like funny things? Do you especially like funny things related to Star Wars? Read this and die laughing.