I'm not really all that mysterious

flashback: the unit

Love is watching someone die.

And it came to me then that every plan
is a tiny prayer to Father Time,
as I stared at my shoes in the ICU
that reeked of piss and 409.

—”What Sarah Said” by Death Cab for Cutie

I’m continuing to read S.’s narrative of her time spent working in the ICU and I am flung back to my own time in that hellish pit of despair. I did my own ICU intern month around this time of year, and looking back at my blog entries at that time, I barely wrote anything at all. Mostly because I was living in the ICU the entire month, and the only reason I would go home would be to sleep and shower.

But the only times I managed to vent my sadness and frustration actually bracketed that month of pain.

Before I started the ICU, I cross-covered for Peds Hem-Onc, and that pretty much set the tone for the next couple of months.

Despite the suffering and the death I was confronted with every day, I managed to stay mostly narcissistic, thinking about nothing but my own misery, although peripherally aware that, as bad as it got, at least I wasn’t sick.

(Rule #4 from “The House of God”: The patient is the one with the disease. Or, as my senior in psychiatry said back when I was a 3rd year medical student, “At least you don’t have lymphoma.”)

The madness continued, as I found myself marooned in the Bone Marrow Transplant Unit, blindsided by Death almost every day, floundering and flailing like a drowning man, as I tried to actually take on cancer, and failing miserably.

For better, or for worse, I made it through somehow without needing a psychiatric hospitalization. I’ve had to face death again on more than a few occasions, but I don’t not if I just got used to it and stopped caring, or it really got easier.

Don’t get me wrong. I still have my regrets. But I can honestly say I tried my best, to not let my patients suffer needlessly, and to send them peacefully on to whatever comes next.

I learned that there is actually such a thing as a good death. To be as pain-free as possible. To tie up all the loose-ends. To say goodbye, without grudges, without too much regret.

At least I can say I tried my best.

But we do a lot of things in those cold sterile rooms that make no sense whatsoever. But you still have to do them.

Even though you knew they were going to die, that you could almost pinpoint it to the hour—even though you knew they were going to die, because you were the one who was purposefully pulling out the tube, and letting nature take its course, at the behest of the family members, or at the behest of the patient, who was able to record their final wishes before they slipped into that awful twilight unconsciousness of grave illness—even though the monitors display quite clearly that the patient is not breathing, that the heart has stopped pumping—you still have to go in there and listen for sounds that you know you won’t hear.

He’s dead, Jim

—Bones from “Star Trek”

I’ve gotten really good at stating the obvious.

Even when you know they’re dying, and there’s nothing you could possibly do to stop that downward spiral, you still have to start chest compressions on and crack the ribs of someone whom you haven’t been able to contact the loved ones of, and whose last desire before slipping into unconsciousness was for us to do “everything that could be done.” Never mind that her veins are filled more with bacteria and pus than with blood, and the bacteria are so resistant to treatment that you might as well be giving her sugar water instead of antibiotics. Never mind that when your heart stops while you’re in septic shock, that you ain’t doing anyone any favors by bringing them back, with their brain all turned to mush by the lack of oxygen, and the bacteria basically eating away at gray matter.

Never mind that, for all intents and purposes, you basically killed her when you stuck that tube down her throat and put her under, because there was no way she could breathe with her chest 75% filled with incurable tumor no matter what you did, and at the rate they were growing, her heart and lungs would be completely wrecked by cancer in 48 hours.

Never mind that the surgeons have tried for four weeks, and now you’ve tried for another four weeks, and even though she was completely awake and alert and communicative, you couldn’t pull that tube out of her throat, and all it seemed that you were doing was prolonging agony, and why do I feel evil for being relieved that we finally let her go? Am I just rationalizing?

Never mind that he had been all ready to go home when disaster struck, and a vessel burst within his gut. His brain died a little that day, and probably died a little more as we flogged him back to what you could technically call life, but after that he just sat there, writhing in delirium, and maybe there were a few moments when he could see his daughter clearly, but for the most part he was convulsing uncontrollably, untouchable by anything we tried.

I don’t know. Thinking back about all these cases—all these people—many of whom I never knew when they were just like me—laughing, talking, playing, working—was it enough?

I guess I’ve been through enough to know that no one is ever going to be able to answer that question for me.

‘Cause there’s no comfort in the waiting room.
Just nervous faces bracing for bad news.
And then the nurse comes ‘round and everyone lift their heads,
but I’m thinking of what Sarah said:
That love is watching someone die.

—”What Sarah Said” by Death Cab for Cutie
Death Cab for Cutie • What Sarah Said
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