Death is Coming

Death is coming, is your constant companion, is holding your hand right now.  No one has more patience than death, but no one can be more greedy either.  Or as tender.  Or as cruel.

The way we live our lives is interesting.  Intellectually we know the deal:   We are born.  We live.  We die.   But here’s what we do.  We celebrate birth. We take Life for granted.  We fear Death and shun it.

When a new baby arrives, joins our family it renews our hope in the world.  We relish the gift of life knowing Nature is intact, operating according to a miraculous plan.  Each year we celebrate the birth again.  As I write this, for instance it is the birthday of my middle child, my second son, Oliver.  On the day he was born I received him with my own hands, in our home, welcoming him to this world.

This morning he was up before the Sun, yearning to seize the day.  He is fourteen.  He had agreed, last night, to go for a sunrise bike ride along the cliffs above the ocean with my wife, Cecile.  The view across Monterey Bay to the Santa Lucia Range is clear today with the water a slate grey, and bands of watermelon and papaya brightening the sky behind the shadowy purple ridge line.  It is a fine morning to be up celebrating the gift of life with the dawning of a new day.  And who better to share it with than the one who carried you and delivered you and nurtured you, who brought you across the mysterious threshold, risking her own life in the process.

It is thin and delicate membrane that separates the Before from Here, and Here from Hereafter.   Mothers occupy an ethereal guard post, straddling the portal into our earthly world.  I’ll bet most of them haven’t pondered the notion that the moment of their baby’s birth may be the closest they’ve ever been to death.  It is a moment out of our control, beyond the confines of manners and propriety and a time when Death can take you.  Usually it doesn’t.  I can’t say how grateful I am that our lives in my family haven’t been  touched that way.  I say this with the perspective of one who has been there when the gates have come unhinged and didn’t open or close the way they are meant to.

In such moments, as a nurse, I am a person in the presence of strangers who one minute are filled with the expectation of their greatest joy and are the next moment gaping down the abysmal maw of dark eternity.   It is hard not to feel out of place, like an intruder.  So many thoughts and feelings slam against the  shores of my being from inside and outside with a rapacious fury, yet I have to center myself and become a pillar of strength in that moment.  Though I feel their loss intensely, I am no good to them unless I can insulate myself at that moment from the strength of my own emotions and provide a solid grounding presence.  Sometimes I will just be with them.  Sometimes people will need physical touch to keep them here in this place, however tumultuous or lonely or damned it may feel, they need to stay here, on this side of the membrane.  Sometimes it is words, words that find their place and come from who knows where to keep a mother, or father from falling into a grief with no bottom.  It doesn’t seem real.   It is all wrong.  But nothing is more real or final.  

My first day of orientation on the job Death was already there when I got there, serving me notice, letting me know who’s the Boss.  Two girls walking to school had been hit by a car.  They were fifteen.  They were in the crosswalk.  The driver of the car had stopped at the intersesction, then proceeded making a turn toward the rising Sun, which for a brief moment blinded him.  That was all it took.  That brief moment became locked in a broken chronogram, which instead of passing without notice became etched into the memories of  people who were there.  One of the girls suffered a femur fracture and needed surgery, but the other had a head injury and was killed.  I remember the injured girl screaming angrily, asking why she and her friend were being kept separated, why she couldn’t see her friend.  Hers were just the first of the heartbroken, disbelieving chorus who came in waves, each joining and renewing the mournful keening that is still in my ears eighteen years later.

That day put a mark on me.  It made me look at each day differently than I had before.  Maybe most of the people who know me don’t know where my sudden dark and inappropriate “humor” comes from.  Well, it comes from experiences like this.  That girl screaming to see her dead friend.  The wailing of her parents, siblings, grandparents, aunts and uncles as they came in and learned she was gone.  The weight of helplessness and guilt for the destitute driver as the unthinkable reality of having killed an innocent girl on her way to school caught him and wouldn’t let go.  Wouldn’t ever let go.  He was there too,  in another room devastated by what he had done.  He was trying not to let the gravity of what had happened collapse his psyche in on itself, but being unable to do it.  We were trying to help with drugs, something to calm and slow his mind down and create a protective buffer against the immediacy and permanence of the moment.

I can’t even write this without weeping.  But I guess that is why I need to write it, to try to find a way of making peace with the terrible, unacceptable reality of being there, as a stranger in the presence of my fellow human beings as they are visited by Death. 


Astigmatic Visions

After 18 years in the ER I’ve come to recognize something.  I’m sick.  Not ill mind you, just not quite conceptually concentric.  I never pondered the word  “Eccentric” before but I think I am described obliquely within its circumference.  I actually knew it long before now, but reflecting on my experiences and how I got to this moment I see it is a striking feature of the landscape.  Inescapable really.  That’s why I thought it would be appropriate, and honest, to give fair warning that the musings herein could be called “Astigmatic”.

My eye doctor once asked me how old I was when I first got glasses.  I was fifteen.  I had just recently gotten braces as well, but that’s a different story.  He said I probably needed glasses much younger than that based on my astigmatism.  He’s a charming man.  But to the point, my vision doesn’t work properly and needs a lot of help.  Optical Physics can correct physically for the visual (must I use the word?) defect. For those formative fifteen years though my mind was told by my eyes that the world was a certain way.  What did that do to the shape of my mind?

My eyes could not conform to a uniform shape to bend  light without distorting it.  Is it possible then that my mind had to bend to try to effect some sort of post production image manipulation?  Was I destined to have a warped view of the world?  I don’t know, but it’s interesting to  turn the idea over.  It is one of those physical fact versus perception philosophical questions like the tree falling in the forest: if there is no-one there to hear it does it make a sound?  Is the world the way I see it because my seeing it that way makes it so? Does my perception shape the world, or does the world shape my perception?

Just a few days ago a coworker and I were laughing about a situation she had gotten into.  She was in trouble with her adult daughter for a gift she had given her.  I don’t have permission to give specifics of the event, but the gift, given as a joke which was funny to my friend was received as distasteful and insensitive.  On hearing the story I thought it was a great gift. Very humorous. It had to do with a hard time this person’s daughter had gone through.  For sure it was inappropriate, but that’s where the fun lay…for some of us.  That’s the thing, every job has a personality type or range of personalities that suit a person to the work.  In the ER you have to be able to laugh at things that get pretty dark.  It’s either get chewed up and spat out or find a way to laugh in the face of some ugly situations.

I can’t even count the times I’ve heard, “That’s not funny Dad!”, or, “Miguel, can you please keep your work humor at work?”.  It’s hard to do.  In a sense, I live in two worlds that are very different from each other.  They require two different ways of being, of facing and responding to situations.  Sometimes I get home and haven’t yet shifted gears from gritty grunge, prickly shield Miguel to quiet listening, okay to be around little kids Miguel.  The Fight or Flight option hasn’t defaulted back to Harmonious Home life, softer quieter mode and I’ll easily say something inappropriate.  The same words coming out my mouth which would have been met with appreciation and gratitude an hour before will l and me in the dog house if I don’t reset in time.

Here’s a true story:  A young man in his early twenties, was brought in by ambulance having been saved from drowning by his girlfriend.  She had hauled him out of the water after he had fallen in head first off a rock jetty.  She really did save his life.  But here’s the (funny) part. The reason he fell into the water is because he fainted.  So why did he faint?  Well, you know those rock jetties, covered in barnacles and what not.  It can take a little scrambling on all fours to navigate the boulders.  In the course of this recreation the strapping buck got a scrape on his hand from a barnacle.  He felt it and looked and saw a tiny ribbon of blood, became light headed and fainted right into the water.   She rescued him, revived him a bit, called 911 and  little while later I was hearing this timeline of events.  While I’m hearing the report from the paramedics it pops into my head what a shame it was she didn’t just cut her losses right then and let him go.  I mean he was fine.  No head injury.  No serious wound.  No water in the lungs.  Fine.  Of course I wouldn’t literally advocate such a proposition, letting him drown to save a lifetime of dreary,  mollycoddling, but the inkling of the idea had popped itself into my head an struck me funny.  So much so that when I got home and the boys asked me what the funniest thing was at work that day, I just blurted out the story.  They were horrified and said so.  Damn kids.

Sick, inappropriate, funny?  Who is to say?  Where do you draw the line?  And how well do you see the spot where the line is to be drawn?

Welcome to “Welcome to the Goat Rodeo”

What does he mean , “Welcome to the Goat Rodeo”?

I have long intended to write about my experiences in the ER.  It’s an idea I’ve kept filed in the back of my mind waiting for a future date when I have an abundance of time and can sort through the mire.  Tomorrow I turn 55 and the lush landscape of leisure time I vaguely imagined isn’t anywhere on the horizon.  In fact time is only compressing and accelerating, so I figure now is as good a time as any to grab a hot torch and light up a bit of my particular vision.  But what is that vision and why do I call it astigmatic?

I am a RN in the ER at a community hospital on California’s Central Coast.  One great thing about the job is you just never know what is going to happen in the course of a day.  One very memorable day a few years ago will remain forever clear and bright in my mind.  It is from an event on this day that I have taken the name of my blog.

It was was during the time of year when influenza and similar respiratory viruses are laying people low right and left.  It was also a year when the CDC and mainstream media were trying (and to dramatic effect succeeding) at terrifying the general public about this, that or the other “Deadly” flu variant.  As you may be able to imagine the media hype led to oodles of mostly not very sick people thronging to the ER.  I know, I know… you’re thinking, “But if they’re not very sick why did they go to the ER?”  I encourage you to come in during flu season some time and conduct a poll about it in the lobby.  Maybe you can answer the question.  I, however will get crucified if I broach the subject with a patient or their family.

On the day I’m talking about I was assigned to triage.  This is the job where a nurse must sort the patients and determine who will see the doctor first.  Our ER has a capacity of 12 beds plus space in the hallways for 4 gurneys, that have next to no privacy for when things get hopping.   So when we get more than 16 patients someone isn’t going to get a bed.  Not right away anyway.  That’s just the math.  I take no joy in making people wait.  No-one likes it.  Patients certainly don’t.  People come to the ER, many of them thinking something along the lines of , “Isn’t this the Emergency Department?  I came to the Emergency Department because I need immediate medical attention”.  Something like that.  “So what do you mean I have to wait?  What if I was dying?  Would I just die here?”  We get a lot of that.  There are two other parts to the indignity of waiting and really they are just down to chance.

1.  People want to know how long they will be made to wait.  That’s natural.  But realistically it is a trap to try to answer with anything approaching an accurate estimate.  All the same we are supposed to try, and I do try.  The problem is I kind of suck at it.  The range of variables in play include: the acuity of patients already in the ER; will they get quickly in and out or will they require a lengthy battery of diagnostic tests?  Who is going to walk in the door next and how sick will they be?  Will we get Ambulance traffic between the time I venture an estimate and when the guy asking gets in.  I don’t want to over-estimate and depress people, but I don’t want to under-estimate either and have people coming up to the triage door tapping on their watches, interrupting the process and demanding an updated (yet equally unrealistic) estimate of the wait time every few minutes once their originally guessed at timeframe has come and gone.

2.  People who come in after you will go into the ER before you.  I know, I know!  “That’s not fair!  I have been waiting here and you just let that other guy go right in!”  Now this is the really hard part and the part that gets people really very, verging on homicidally,  ANGRY at me.  It is not hard to understand why people get mad: they come to the ER thinking they will get right in.  They are not feeling well.  A lot of the time they’re in pain.  Or they are accompanying someone they love and care about who is in pain, or is bleeding, or thinks they broke their ankle, or was in a car crash 2 days ago and feels worse now, or has had a cough for 2 weeks and got a fever this morning… all these people feel badly and have a right to receive medical attention in the ER.  But I have to rely on my training and experience to judge from an emergency medical point of view who is next.  If it’s not you and if you’ve been waiting a considerable length of time already… well you might be miffed.  I could go on and I will do another triage only post another time.

Anyway this was one of those kind of days, the department was full, it was flu season, people were feeling lousy and they were getting restless.  There was nowhere for me to put anyone.  A mom came in with her daughter who had minor flulike symptoms and registered to see the ER Doc.  I had more patients waiting than we could accommodate if the entire ER emptied that second.  We had been taking a beating all day.  After less than 5 minutes waiting that mom came up to my door and loudly announced, “I’m going to leave”.  I asked her if she would sign a form we have acknowledging that she was making the decision for her daughter to leave.  We were not refusing to see her, we just couldn’t see her right then.  She agreed to sign it.  I was actually a little surprised.  A lot of times people aren’t in a mood to sign such an acknowledgement.  When she handed it back to me she gave me an unexpected gift.  On her paper she had scrawled, “This place is a Goat Rodeo!”

That made my day right there.  I busted out laughing and went around and showed my work-mates.  Each and every one of us had a good belly laugh.  Not one of us had ever heard that expression before and the freshness of it and imagining the absurdity of a  rodeo of goats instead of bulls and horses, with clowns to distract the goats after they bucked off a hapless cowboy.  It was meant as an insult, I’m sure, but it had the exact opposite effect and it was an immediate pressure relief for us all.

The next day I wore a cowboy hat into work with a home made Rodeo champion’s belt buckle on my waist.  We all got another good laugh out of it and held onto that unexpected humor which had come out of such tension and it helped us through the day.  Thinking about it continues to make me laugh and helps me persevere when things are hard.

I have three children ( blessings each one of them) and the two older ones like to ask me when I get home from work,” What was the funniest thing that happened today?”.  When I told them about the Goat Rodeo lady they agreed that was a real top contender and suggested that whenever I get around to writing my book I should call it “Welcome to the Goat Rodeo”.

And so here we go.