Getting ready

I'm reading a book called Broken Open. It's not a book about childbirth (believe it or not.) It's a book that's been in our house since someone gave to katy last year when she was going thru a "Pheonix Process".

[The mythical Phoenix bird sat in the fire of change until the flames had consumed his old self. Then he rose from the ashes a new bird—stronger and wiser.]

The giver of the book was an important person from katy's past, but a stranger to me- someone I regarded with at least a dollop of suspicion. Broken Open sat on our night stand for weeks or months and though the cover was appealing and the title interesting, I never opened it. In truth, I hated it; or at a minimum resented it. Even without being told, i knew the book represented a place or journey I was not necessarily invited to travel with my wife.

At some point, the mostly unread book got moved to the bookshelf in the office and a few months ago I found it during a restless bout of insomnia. i tore through the introduction and the first few sections in a matter of hours and returned to my bed comforted and peaceful. I was conscious of the manner by which the book had fallen into my hands- the painful circumstances that brought it into my house, but after reading a few hours worth, I felt centered in a way i can't describe. It was like hearing about something you never knew existed before and like proof of something you have somehow always known.

This pregnancy has been mostly wonderful. It has also brought up some serious pondering- inside of a woman that probably has spent too much of her life "pondering." The section I turned to tonight is called Birth and Death. "Uh-oh," I thought, here's the part that's going to send me over the edge (and make my blog readers think I am utterly obsessed with death right now...)

Instead, it brought me back to a time and career I haven't considered in a while. And it made me embarrassed that of all the labels on this blog, I've never written a post that should have been labelled NURSING.

I spent the better part of seven years working in in-patient care. And during much of that time, I was literally fending off, beating back, or sitting patiently near, holding a hand, stroking a brow, holding open a door for death. I saw a lot of people die and it is one of the strangest and greatest blessings in my life to have participated in the runoff and aftermath of each. All of them were uniquely tragic and simultaneously insignificant in the scheme of the history of the universe...

Working in an ICU- if you do it right- you get to practice science in complete confidence without ever sacrificing the knowledge, the surest certainty, that there are things beyond the reach and explanation of science. You get to operate within both frameworks- hard empirical, factual, numerical, chemical, formulaic, algorithmic, provable, systemic, time-honored, hard-won knowledge; and instinctive, crunchy-hippy, celestial, emotional, soulful, non-sensical, improbable, time-honored knowing. There are hundreds of stories inside of me, examples of each. And perhaps now is the time to start writing them down. Some of my favorite are the ones where science, protocol, and honest, rational, therapeutic dialogue save the day. But the one that is so clear in my mind right now is of the other variety:

The summer I worked on the island, I took care of an elderly man who was in the ICU for basic cardiac observation until an ambulance took him on a ferry the next morning to get him to the big city for a cardiac cath. He was very stable- even by "island ICU" standards. More than that, he was pleasant, gentle and kind. It looked to be a quiet night for me, I easily completed admission paperwork while chatting with him and he wanted to go to bed early. At some point, he woke and called me over. "Whose that guy out there? What is he saying?" I looked out his window into a dark, locked courtyard. It was possible there was someone out there but unlikely. Now I realized my patient/friend might be experiencing confusion we often refer to as "sundowning"- when it gets dark, the sanity slips away a little, or sometimes a lot.

I drew the curtains and repositioned the gentleman- taking time to use a warm cloth on his back and follow up with a long, relaxing back rub. He thanked me, made sweet conversation that indicated complete sanity and closed his eyes to fall back asleep. Then he woke again.

"Tell him to leave me alone. I don't want to go out there."

I stared at the closed, vinyl drapes. "Who is he? do you know him?" I asked.

"No, he is old. But he wants me to go with him."

The hairs on my neck stood up and I shivered like in a mystery novel.

I check his vitals, checked his nitro drip, and checked his code status- DNR. I asked him how he was feeling, if there was any pain, if there was anything he needed. "Only to get some sleep." He smiled sweetly, "I have a big day tomorrow," he reminded me, again referring to the surgical procedure and reiterating a competent memory and normal level of consciousness.

"Are you afraid?" I asked.

"No," he replied, "I think they'll take good care of me." He missed that I wasn't asking about his impending medical procedure, but about the man that only one of us could see. I hesitated and then pushed it one inch further...

"What does the man look like?"

"He's right there. Don't you see him? He has a beard. He wants me to go with him... but I think I'll stay here with you." He smiled in his kind, calm way. He fell asleep and a few hours later died. I knew this was coming. I don't know how, but I can tell you that I watched this man carefully for any scientific clue that his heart would stop, and there was none. There was no labored breathing, no pain, no change in vital signs until the monitor indicated his heart had stopped. There was no resuscitation- per his documented wishes. There was no medical explanation not only for his death that night but also for me to have known it was coming. It was hogwash, hokey, and freaky, but it was real and somehow predictable based on his and my observations. That was the night I saw death. Or more accurately, the night someone I was with saw death and described death's appearance to me. I've always wondered if I should have had a conversation with my patient that the man he saw might be coming to take him from this life, but at the time, that option seemed impossible and cruel.

I am fully accepting of the plausibility of coincidence. It is frequently documented that there is confusion and hallucination before death. My take on this story might be wrong. If you debate me, I won't argue my point very hard or long. But you weren't there and I was. And I know what I believe. And I don't think my experience of this night proves or disproves anything- so there is barely a reason to debate.

Before we die, we are all transformed countless times by experiences, miracles, and devastations. Where we encounter fear, there is also life and love to enjoy. For every death, there is a birth. And every birth breaks us wide open... Let the stretching and bursting begin!