"Well, You Did It"

I was the on-call chaplain that night.  This meant that I was the only person from Pastoral Care in the hospital.  I carried the beeper and had a quiet little room where I could sleep if things weren't busy.  My shift began at 5 p.m. and would end at 7 a.m.

The beeper went off around eight o'clock.  It was the head nurse from the ER.  A woman had been brought into the hospital after a successful suicide attempt.  Her family had been contacted and would be coming in to see her. Would I please go to the viewing room and wait for the family. 

The woman was in her sixties, not unattractive, and dressed in casual clothing.  There were no marks on her; she had taken pills.  I felt uneasy as I waited with her, and this was unusual.  The viewing room felt exceptionally cold.

When her adult children arrived, they were angry.  They did not seem at all sad.  "Well, you did it," said one of them.  And the rest of them echoed that sentiment.  They berated their mother for what she had done.  They were very, very angry.  But they showed no signs of wanting to leave.  It was confusing.  My task was simply to Be With Them; if I could do more, that was good.  But I was at a loss as to how I could work with this family.  Their anger was so bitter and pervasive.

Then came a knock on the door.  It was a cousin, who was a pastor in the Swedenborgian tradition, a Christian faith very, very different from my own Lutheran one.

"Well, she did it," they told him.  They remained stiff and angry as he looked first at the mother and then at them. 

The cousin waited a bit.  Then he said, "You know, we are only accountable for those things that we do when we are not being forced and when we are not in pain."  Another pause.  "And she spoke with me many times about the pain that she was in."

And then they began to grieve, and the room felt warmer.     

Cranberry Girls

It was a terrible shift, really. One of the worst I've ever had.

There were two Codes on the same patient; he didn't respond to the second one.

There were five traumas, one of which was a man about whom the paramedic said, "Be very careful with his shoes. They cost a thousand dollars." For those of us in the trauma bay not yet directly working with the patient, our attention was instantly diverted to the floor.

Ugh.

There were a couple cardiac arrests. Neither patient responded. There was a death of a very sick man whose surviving sister's main response was that she did not have the money to pay for his funeral. A visit to a patient whose husband and daughter hated each other and didn't try to hide it.

And the worst was at the very end of the shift. Another cardiac arrest, this one for a man in his twenties. And someone had mistakenly brought the patient's siblings back to his cubicle without the doctor's having met with them first, to let them know he had died.

It was a blur of horror, the ultimate awful, awful shift.

Except.

As a hospital chaplain, one doesn't receive very many happy calls. But on this dreadful day there was one. And it was truly wonderful.

It was a nurse from one of the intensive care units. It seemed that her patient's daughter's wedding had been scheduled for that day. And the patient was still in an ICU and unable to go to the church, much less the reception. And so the dear bride unselfishly knew what to do. The nurse wanted me to tell her that it was okay to have a wedding in the waiting area outside the ICU; they would bring the patient from her room for the ceremony. I said that of course it was all right, but was she sure that was the right place? I suggested an alternate venue: the hospital chapel, a beautiful setting on the ground floor. Would the patient be able to be brought there for a 20-minute ceremony? Yes, she would. I told the nurse to let the nursing supervisor know what was going on and made a note to wander downstairs around two o'clock.

Shortly after one o'clock, there was a bit of a commotion in the lobby. Men in tuxedos, little girls in fairy princess flower girl dresses, a half dozen bridesmaids wearing cranberry dresses, and the bride, resplendent in her sparkling gem-studded dress, all shaking off snowflakes and providing their own flurry of activity had arrived and were heading up to visit the mother of the bride. They paused here and there for photos. And I was called away for another situation.

With a few minutes to spare, the latest awfulness was resolved, and I made my way to the chapel. The nursing supervisor was there, helping the bride and groom make the room their own. Photos were made of the couple at the altar with the snow falling in the window behind. "How can I help?" was my immediate question. The supervisor sent me up to the ICU to escort the wedding party to the ground floor. It took two elevators to hold all of us. Everyone was settled in place and soon the guest of honor arrived in her wheelchair with an oxygen pack and a nurse or two. And then it was time. Somehow the little organ began playing "Here Comes the Bride," and the four little flower girls and the ring bearer escorted the bride and her older brother into the chapel. I closed the door and became the self-appointed guard so that no one would disturb this magical moment.

So, the worst shift ever ultimately came to an end, as they all do. It will be a shift that will stay with me for a while. I'll forget the deaths, the impoverished sister, the traumas (but maybe not the shoes), the cardiac arrests and the codes. What I'll remember is the bride -- beautiful inside as well as out -- and those lovely young girls, tall and proud in their cranberry gowns, doing the right thing.

The Good Neighbor

It happened again on Saturday night. A too-young man experienced cardiac arrest, leaving behind a too-young widow and children: 10, 8, and 5. There's a slide show of images that plays through my mind: the tremendous efforts of the emergency room team, the stoicism of the patient's German mother, the sincerity of the in-charge physician, and the despair of the wife. The slide show tends to stick, however, when it comes to the response of Sandy, the next-door neighbor.

My experience is that humans are programmed against willingly taking responsibility for their failings. The preschooler who says he did not get into the chocolate cake, despite the icing evidence around his lips. The motorist who says, "It was yellow, officer. It wasn't red." "It wasn't my fault; don't blame me." We just do not want things to be our fault. It's how we're made.

And yet, I've seen it time and time again in our emergency room. A sudden death and the family member will say, "She wasn't feeling right all afternoon. I should have brought her here sooner." "I should never have let him go upstairs." "I should have checked on him earlier." This uncharacteristic claim of responsibility on the part of the bereaved, I think, is some mixed-up attempt of the psyche to buy back time, to get a do-over, to change history. A form of bargaining, a way to postpone accepting the unwelcome reality.

When we walked into the conference room, the two neighbors were anxiously waiting for good news. But it wasn't to be. The nurse told them, gently but clearly, that the patient had died. One of the women had done CPR at the scene. Her immediate response to the unhappy news was, "I should have done more! I should have continued the chest compressions! I should have . . . ." Taking the responsibility for this death upon herself. The wise nurse very, very quickly put a stop to it. "There is nothing you could have done that would have changed the outcome."

Sandy struggled to accept this. Then her thoughts turned to the practical. She telephoned her husband who was with the children, children who matched her own in ages. A plan was devised that he would take all of the kids inside and put on a movie. And after the movie, the kids would all have a sleep-over. Just like they often did. They'd have one more night of their normal lives, and their mother would somehow find a way to tell them in the morning. Sandy was organized, caring, decisive. She had tried to save the man's life and now she was protecting his children. Could anyone have a better neighbor?

I left the two women in the conference room to return to the wife and mother, to tell them of the plan for the children. The wife was doing the typical cycling from excruciating sorrow to attention to detail. She'd phoned her own mother. Her mother-in-law had called the patient's brother who was on his way to the hospital, coming from about an hour away. The pastor would be arriving in a few minutes. It would be okay for the neighbors to go home; she had enough support.

When I returned to the conference room, the other neighbor was holding Sandy in her arms. The families were so close, the loss so devastating. The organized, efficient Sandy had vanished. "I should have started the CPR sooner! I didn't do the chest compressions right! I could have done more!"

"No," I told her in a voice stronger than I knew I had at that moment. "You did nothing wrong. You did everything right. The outcome wouldn't have changed. Sandy, you gave him a chance."

I wonder if she'll ever believe me.

Yesterday

Yesterday morning my friend of forty-plus years broke her blog silence with a lovely post about how she met her husband. It would have been their sixty-fifth wedding anniversary. She wrote about their courtship, his hopes for the future, and recaptured the feelings of a college girl, meeting a man and knowing her life was about to change. Near the end of her post, she wrote, "I don't intend to make this a story of our marriage, which was cut short by his death in a car accident when he was only thirty-eight. He was teaching at [the university] by that time and working on his doctoral dissertation We had three girls and a boy on the way when that happened. It was a terrible loss, of course. I had never thought that one could survive such a thing, but we did. He had given me that strength."

On and off throughout the day, I thought about my friend's post. At the time we met, she was a single mom with four pre-pubescent and pre-pre-pubescent kids. I was young, not-long-married, and full of my own hopes. I seldom thought of what her life had been before we met.

Her post stayed with me throughout the day. I thought of this young woman, alone with all of this responsibility. I wondered how she had been able to get out of bed each morning. "He had given me that strength."

In the afternoon, I went to work at the hospital. When my colleague gave me report of his day, after mentioning a need for an advance directive and a couple of minor traumas, he said, "We had a real tragedy here today. A young man, 32-years-old, collapsed at the gym with cardiac arrest. He leaves three young children."

My stomach tightened. Not because it reminded me of my old friend, but because somehow, instinctively, I knew who the man, the children, the wife were. My colleague didn't say any names, but I knew. I kept it to myself, I remained professional, and only after John had left and I was alone in the on-call room did I have the courage to unfold the hand-off sheet. The name there was the one I expected.

There's a young woman at our church who is involved and active among the younger set. She's stylish and attractive; no, she is just downright cute. She's so adorable that she was able to show up at worship without trying to cover the ingrowing hair that follows chemotherapy. For this woman has spent the past months recovering from breast cancer. At her age. Her children (5, 3, and 1 respectively) are beautiful and fashionably dressed. Her husband was equally handsome in his own way, and obviously adored her. A family for a magazine cover.

Two questions bombarded my brain. How had I known it was him? There must be thousands of 32-year-old men with three children. And how will she be able to get out of bed in the morning? I pray that He has given her that strength.

I went about my work. Fortunately, it was a stress-free shift. I spent an hour with a woman concerned about her sick mother's future. I discussed an advance directive with another woman. I delivered a Bible to a very nice man and prayed for his healing. A moment of panic when a pediatric trauma was called turned to gratitude that the trampolinist wasn't seriously hurt. And then it was time to go home to my husband, who I held a bit more tightly than usual.

Mr. P.

I knew who he was the minute he said his name, even though the catch in his voice made him a wee bit hard to understand. I was sitting in the office writing my notes from the last trauma when the telephone rang. And, as I mentioned, when he said who he was and that he had to talk to somebody, his image flashed up before me.

Anyone who ever went to a viewing at the Protestant funeral home in our town knows who he is. A man of average height and average build. He wore a black suit, of course, and was immaculate. You might not even notice him if it weren't for his face. It was distinctive. His features were chiseled, his nose large and angular and, of course, there was no smile. There was something a bit intimidating about him; you just knew he wouldn't be one to engage in small talk or -- God forbid -- banter. I kind of imagined that he had a wife who was a little bit afraid of him and three or four children who toed the line impeccably. Not that I thought him to be mean, no, not that. He just looked like someone who knew exactly how things should be done and, by cracky, they were going to be done that way.

But the voice that I'd never heard before, belied the image. He sounded fragile. Frightened. Vulnerable.

He was seated on the side of the bed and when I asked if I could sit down, he apologized for not being able to pull the chair over for me. As his eyes brimmed over with his tears, I took his hand and gently asked, "What's going on?"

His opening words undid everything I'd ever presumed about him. "I have a little doggy," he began. "And I love her."

We spent about forty-five minutes together, an unusually long time for a visit. He told me his life's story. He'd grown up upstate and learned his trade there. Upon completing mortuary school, he learned of a job down here and met with the owner of the funeral home. On first meeting they both knew it would work. He worked at that funeral home for sixty years. There was no cowering wife, no nervous children. Not much at all in the way of family -- a difficult hypochondriac of a sister and her son, Joel.

He was a sweet, gentle, and lovely man. Appearances, as they say, can be deceiving.

He'd come to the hospital unexpectedly, as so many do. And he hadn't planned on staying. But there he was, and his dog, Ember, was very much on his mind. On the day of admission, the nephew had gone over to his home, let the dog out, and fed her. He'd gone back again the next morning to tend her again. Then in the afternoon, the nephew and the sister had come to the hospital to see him. The visit hadn't gone well. The sister apparently had gotten out of a sick bed to come, and Joel hadn't been happy about having to transport her. They had words. The family had left in a bit of a huff.

And now my patient was worried that the nephew wouldn't continue to care for Ember.

My non-medically trained quick assessment suggested to me that this was no short stay. Mr. P. was shaky and frail and he admitted to being unsteady on his feet, although he had been able to open the door to let Ember out back to transact her business. I foresaw another day or so in hospital and then a stay in rehab. Mr. P. is 88.

I held his hand. I passed him tissues. And I listened. In due time, having gotten it all out, he focused on his main issue: his doggy's wellbeing. He seemed at a loss. We talked about what he might do and decided he would give Joel a phone call and say that he wasn't feeling good about how their visit had gone and just wondered if he and Joel were okay. If Joel was unable to continue caring for Ember, Mr. P. would ask him to take her to the kennel and pay him for doing so. We had a plan.

I had hoped to pop in again the next day before leaving, just to see how it all worked out. In my mind was the back-up plan of contacting my own dog boarder, a young mom from my church, who would make Ember feel right at home. But a trauma, and then another got in the way, and this turned into another one of those stories where I'll never know the ending. That's one of the unsettling parts of my work.

Love and Compassion

I just finished reading Paul Kalanithi's masterpiece, When Breath Becomes Air. The writing is exquisite.

A neurosurgical residency graduate who is struck by advanced cancer in his mid-thirties, he writes about his life, his studies, his work, his family and how all of these aspects tie together.

I have to take the book back to the library, but need to keep this one passage:

"As a resident, my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness. When a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever color how the family remembers the death, from a peaceful letting go ('Maybe it was his time') to an open sore of regret ('Those doctors didn't listen! They didn't even try to save him!') When there's no place for the scalpel, words are the surgeon's only tool.

For amid that unique suffering invoked by severe brain damage, the suffering often felt more by families than by patients, it is not merely the physicians who do not see the full significance. The families who gather around their beloved -- their beloved whose sheared heads contained battered brains -- do not usually recognize the full significance, either. They see the past, the accumulation of memories, the freshly felt love,* all represented by the body before them. I see the possible futures, the breathing machines connected through a surgical opening in the neck, the pasty liquid dripping in through a hole in the belly, the possible long, painful, and only partial recovery -- or sometimes more likely, no return at all of the person they remember. In these moments I acted not, as I most often did, as death's enemy, but as its ambassador. I had to help those families understand that the person they knew -- the full, vital independent human -- now lived only in the past and that I needed their input to understand what sort of future he or she would want: an easy death or to be strung between bags of fluids going in, others coming out, to persist despite being unable to struggle."

*I would add "their hopes for the future."

A little more than five months ago, I was part of what is a hospital chaplain's worst fear: A Pediatric Level One Trauma. A child the same age as my granddaughter had suffered a febrile seizure while taking a bath. By the time her father found her, her face was under the water and her brain had been deprived of oxygen for several minutes.

"Andrea" was put on a ventilator and the parents were told that she needed to be in a pediatric intensive care unit, so she was choppered to the children's hospital to undergo what my supervisor told me was a last hope procedure: her body temperature was deliberately lowered in the hope of reversing some of the damage to the brain.

This patient has stayed with me like few others. There is a Facebook page where 8-year-old Andrea's parents post daily updates and photographs. They report progress. Daily, they say that she is "working hard." God forgive me, I am skeptical. I so admire their hope, their determination. But sometimes we see what we need to see and these parents need to believe that the girl who went upstairs for a bath will be back with them. I see a vacant look in her eyes, but I so want to be wrong, for them to be right. One of my colleagues said, "It would have been better to have let her go." The words sound heartless; I waiver between condemning her and agreeing.

The community in which the family lives has been astonishing in their support. Fund-raisers of every possible kind have been and will be held. Dozens of meals have been prepared and shared, the neighborhood men have come together to build the first-floor home addition that is now needed. I've never been prouder to be part of this town.

Years ago I spent a weekend at a Quaker retreat center attending a program on medical ethics. One doctor spoke at length about a phenomenon that strikes the children of the Amish community not terribly far away. These children progress normally for a few years and then, without warning, begin to regress until they are once again infants, but in growing bodies. They are kept with their families, brought to all gatherings, groomed, dressed, and cared for. The doctor said, "These children are not the objects of our love and compassion. They are the source."

The Smell of Evil

Sunday's Gospel was the story of when Jesus went to visit his friend Mary and she massaged his feet with expensive, fragrant ointment. The pastor did a fine job with his sermon, getting us all to think about distinctive, beautiful aromas. He talked of what Mary had done as "the smell of love and kindness." It was a good sermon, and I smiled to myself as I remembered my experience of Friday night.

I could smell something the minute I set foot in the trauma bay. It was a terrible smell -- kind of a strange combination of the dirtiest feet in the world and, erm, poop. I expected the patient to be filthy dirty. Sometimes we'll get a homeless patient who hasn't had a bath or a change of clothes in a long time, and he'll smell pretty ripe. And that is pretty much what I expected.

But when I got up close to him, he wasn't dirty at all. He was neatly shaven and his face was clean. The clothes piled at the foot of the gurney were relatively clean. But the smell was overpowering. It was my  job to ask who I should contact to come to the hospital. He was soft-spoken and he was a bit drifty. He nearly fell asleep while giving me his girlfriend's telephone number. He seemed pleasant enough and I found myself wondering why this young man had been assaulted.

After I contacted his friend, I went out front to update the triage desk with the patient's name. The triage nurse said, "Oh, the assault patient. How's he doing?" I said that he had gone off to CAT Scan but was moving all of his body parts appropriately. Then I added, "He's kind of stinky." Everyone in the trauma bay had been aware of it. The triage nurse said, "Oh, that's the heroin. Heroin addicts have that very distinctive smell about them."

I had no idea.

The smell of love and kindness. And the smell of evil and heroin.