On the Fence

Here is a well articulated and fair article about palliative/terminal sedation. This was a genuine and frightening surprise to me during my first clinical rotation and it continues to be one of those ethical dilemmas with which, inside, I can make no headway. It is probably the number one reason why I have shied away from hospice nursing which I originally suspected to be my calling. My hands and heart don't want to carry the weight. Conscience or cowardice? You decide.

Understanding the Dead

Without memory, there can be no revenge. Lest we forget. Remember me. To you from failing hands we throw. Cries of the thirsty ghosts.


Nothing is more difficult than to understand the dead, I've found; but nothing is more dangerous than to ignore them.

Margaret Atwood, The Blind Assassin

Just a Body

The Kid is ten. Driving home from school last night we had this conversation: "See that dot on their license plate?" he asks, pointing to the car in front of us, "it means that guy's a donor."
"A what? Organ donor? No, they don't put it on your license plate. Someone needing a kidney might run you off the road... they put the dot on your driver's license."


"Oh... Are you a donor?"
"Yes, of course."
"What part of your body?"
"The whole thing."
"Well, that's good. They might as well take it all and help someone else. You won't be needing any of it anymore."
"Does it bother you?"
With some disdain, "No, mom... It's just a body."

Viaticum

The Kid says, "Do you know why there are so many ghosts these days? Because no one ever places obol on the eyes of the dead anymore, so Charon won't let them into the underworld.

But don't worry, Mom. When you die, I'll leave you with two hundred dollars."

Whose Eye is on the Sparrow?

It rains, a gale rises, the big top collapses, fire breaks out, panic, people trample their neighbors to death as faced with the prospect of dying they make the decision, now, swiftly, who matters most. "I matter. I. I. I matter."

...I fly alone, apart from the flock, on long journeys through storm and clear skies to another summer. Hear me!

Towards Another Summer

Rites of Passage

In the doorway stands the nurse's aide looking frazzled and tired, rubber gloved, holding wipes in one hand, her pager in the other, towels tucked under each arm. Her nurse is consulting with a family member and a doc about discharge of another patient. “Sarah,” says the aide, “I need your help. Please.” The nurse gives her the, “I’m-busy-with-another-patient-I’ll-be-there-soon” look that means she could be there in ten minutes or two hours. Since I am only charting at the nurse’s station I offer a hand.

I enter the room and approach the patient in her bed. “Just turn her over, please” says Therese. So, I roll the patient toward me and Therese begins to clean her. All the while I’m talking to the patient, “You’re doing a great job, Mrs. L… Here, lean toward me… Just a little longer now…” I adjust her weight, moving my right hand from her torso to her leg and realize suddenly that her extremities are really cold. I place my left hand on her back and get my face down in her face. Not breathing. My ears feel red and hot. I scan the patient from head to toe. I look at the aide. She is madly cleaning the woman, paying me no mind. Suddenly it dawns on me: the aide knows that the patient is dead. In fact, I find out later, the patient had been dead for over an hour.

Why the aide didn’t apprise me of the situation upon my entering the room is totally beyond me. Why she didn’t say anything when she heard me talking, and, more specifically, giving instruction to, a corpse, is also a mystery. My theory is that she either thinks I am deeply spiritual, or she thinks I'm crazy.

It’s a strange world, the hospital. It makes me thankful for my deep and morbid sense of humor, finally serving me well.

First Do No Harm

The Kid is reading, among other things, The Fortean Times Book of Strange Deaths. He said to me last night after my first med-surg exam, over which I was having mild to massive anxiety, "Mom, you'd better read this; I don't want you to make the same mistake."

"A newborn baby in a Chicago hospital came to an abrupt end when someone accidentally connected the child's heart monitor cables attached to electrodes on the chest and abdomen directly to the mains. Twelve day old Stratton Vasilakos died instantly. Apparently this was caused by a design fault which had resulted in several previous accidents but was supposed to have been corrected."

Somehow that wasn't really the anxiety relief, nor the vote of confidence, I was looking for.

By the way, did you know that "Primum no nocere" is not even in the Hippocratic Oath? I'm no doctor so it doesn't really matter. Interesting, nonetheless. It's actually attributed to the Roman physician, Galen.

Unbroken Circle

On Sunday we went to Tennessee Valley and not only happened upon such a large bobcat that we initially mistook it for a mountain lion, but a beautiful great horned owl. Perhaps foreshadowed by the latter, we were also confronted with a body on the shore. Given the position of Tennessee beach and the tides off of the Marin Headlands, it was pretty likely a jumper.

This was, The Kid pointed out, the closest he'd ever been to a corpse -- which is to say not too close, but close enough to tell us, aided by binoculars, what the man was wearing. There weren't many passers-by that day. Who knows the reason. So we were lone hikers when the coroner's van came by. Once the body was in, and the van passed, The Kid and The Partner both decided it was time to break into song. I scolded them both, unnecessarily imparting the significance of respect for the dead.

"But Mom, we are respecting him," said The Kid."We are singing because we don't know if the circle will be unbroken... we're singing because we wonder if he's a father."

And this was the moment The Kid began to grapple with human mortality. We learned thereafter that when we die he's going to keep a lock of hair from each of our heads in a locket around his neck, and The Partner's umbrella will be forever preserved in a pine box in The Kid's living room -- somewhat like the dog's ashes, which still sit in a tiny box next to his bed, bearing the words, in red sharpied child scrawl: "SAMMY RIP".

Sick

I watched this documentary about Bob Flanagan about ten years ago, but The Partner had never seen it, so this afternoon we headed out and got our hands on a copy from Le Video. The whole experience of the film, for me, has been totally recontexualized. What's different now than then? I now believe it should be requisite viewing for all nursing students. Not into S&M? Can't really deal with someone driving a nail through his penis? Tough. Sit through this movie if you want to know what it is like to have a chronic illness and if you want to know what it's like to die. As a nurse or future nurse, it's important. Allied with some of Flanagan's pain journals, it can really provide a window. We just have to be willing to peer through it.

As for my mom, who I think reads this blog from time to time, you definitely don't need to see it.

Will Says

"The first song that I remember dealing with death in a pretty direct way was "Ebony Eyes". When I was four or five, I listened to the Everly Brothers over and over again, acting out all the songs with the little plastic figurines I got for my birthday, and that was the last song on the record. I could tell that it was a sad song, but I didn't have any idea how sad. It's still something that I value a lot; music that gets in there. If I'm wondering about death and scared about life, then to find some song that addresses it is like, 'Well, if you feel that way the best thing might be to either obliterate consciousness, or to destroy yourself completely....' That's not the kind of music that I like to listen to. But if someone deals with the end of conscious existence in such a way that they're not just trying to ruin your day with it, then it can be pretty great."

I Am Become Death

The number of nuclear warheads in the US, according to a 2002 report from the Natural Resources Defense Council, Nuclear Weapons Databook Project is 10,600 (7,982 deployed, 2,700 hedge/contingency stockpile). The amount of plutonium still in those weapons is 43 metric tons.

Watch The Day After Trinity and Kuroi Ame and then ask yourself why.

"I remember the line from the Hindu text, The Bhagavad Gita: Now, I am become death, the destroyer of worlds."
- Robert Oppenheimer, The Day After Trinity

and I will align myself with nothing...

I had been struggling with my clinical specialty until my community health clinical instructor who was been a L&D nurse for 10 years said to me, "I don't see the predicament. Sometimes, you can't tell the difference between a birth and a death. I've been at plenty of births where I was like 'was that a death?' and plenty of deaths where I was like 'was that a birth?'"

Drawing by Karlynn Jayne Holland.

...and I will enjoin my heart with no-one's
cause I was untried
when I was applied the light of birth.
- "Patience" Royal Stable Music 1997

His Mother Too

It's taken me a while to write about last week's patient. Sometimes, separating the sheer gravity of what it is to be human from the what we carry with us is nearly impossible. But this I have come to understand and to rationalize: there is a lot of tragedy in the world, people die needless and senseless deaths every day. There is horrible suffering. What I have yet to process is how people carry on.

This young man was dying. Thirty years old. I hadn't seen him out of bed all week, but as I was getting ready to head to the cafeteria for lunch, out he waltzed, all six foot five inches of him, one hundred and thirty pounds, asking if it was okay for him to take a walk. "Of course," I replied, "Of course."

At his side was his mother. She hadn't left his bedside since he was admitted to our until, ten days prior. This mother had in the past ten years lost her eldest son, her daughter-in-law and grandson. As she walked away, her youngest son towering over her, I imagined him well, healthy, strong arm around her shoulder in comfort rather than for balance from his weakness. I saw her with a son on either side. Two toddlers, a young mother. I tried hard to shake that image and busied myself with another patient until they had disappeared down the hall.

Eventually I made my way to the cafeteria, maybe twenty minutes had passed. Because the walk was tiring, because they had to stop and rest, I came right up behind the two. They both turned, smiled, greeted me -- looking confused at all of the commotion in the cafeteria, and overwhelmed by the world going on around them. As I watched her guide her son slowly back down another corridor, I whispered after her, "I am a mother too." Though she didn't hear me, she turned, smiled, nodded - and as her son slowly disappeared around the corner, I saw her hands grasp the tiny hands of her two sons, one on either side, swinging them gently - smiling.

I have been for a long time at your side

"I see them! Over there against the stormy sky. They are all there..." ~ Det sjunde inseglet




"By this time I'd had the experience of dying patients at the hospital and I was becoming interested in dying and death and resenting the way I'd been deprived of experience of death almost as I would have resented being deprived of love...By the beginning of the next academic year I switched my studies from embryology to death."
~ Daughter Buffalo

I, Antonius Block, play chess with Death.

Most close friends, loved ones, understand my fascination with death and dying. Well, maybe they don't understand, per se, but they are accepting of it. It's the Norse blood, some say.

After dedicating years to the folkloric study of death rituals and legends, cryonics, anthropology da morte, being deprived of death both by exclusion and by default* I have been reacquainted with it in the clinical setting. What an experience.

*In case you haven't noticed, sans the Veteran's Memorial in the Presidio, there are no cemeteries in San Francisco. I won't say what my mind conjures about the implication of that absence, but when in need, one can always visit Colma, California -- the city which has "inherited [our] hundreds of thousands of bodies." The story goes that the San Francisco board of supervisors "evicted" all of its cemeteries in 1912; by 1937, all the bodies were removed, making us San Francisco the city of the living. The city without the dead. Weird.