LVAD warning

If I had Dick Cheney's blood type I'd be very careful crossing the street for the next few weeks. I really wouldn't want to be the leftover body they find  in an ice filled tub, though I suppose they will find someone younger so I shouldn't worry.

But when you read about it in the major news outlets, it will seem like a lucky break anyway --and be found to be completely aboveboard after an extensive investigations.

So, not to worry.

On Unemployment

RALSTON: How would you have voted on that bill to extend unemployment benefits?


    ANGLE: I would have voted no, because the truth about it is that they keep extending these unemployment benefits to the point where people are afraid to go out and get a job because the job doesn't pay as much as the unemployment benefit does. And what we really need to do is put people back to work. So if you want to ease people back into work, what we need is an unemployment benefit that pays part. You know, you go to work, you have something of a safety net, in unemployment. But just to give them full unemployment benefits and then extend those for two years or more gets them not only out of the working class but it also depreciates their skills, so they're not actually able to go out and compete in that workforce, so what we really want, is we want something that stimulates a group of people to go back into what we know as that free market.

Ralston then played a clip of Angle, explaining her position thusly: "You can make more money on unemployment than you can going down and getting one of those jobs that is an honest job but it doesn't pay as much. We've put in so much entitlement into our government that we really have spoiled our citizenry."

It’s hard to argue with Sharon Angle -- she’s not wrong, but it’s going to be hard to watch the results of the new cold turkey method of fiscal responsibility if she’s right, and if things stand the way they are standing right now. Unemployment may indeed be the opiate of the people, but it’s important to remember that societies really give the wretched masses narcotics to keep them tame -- so they don’t go around with too much time to think about changing things or breaking things. Fat unemployed white people make a lot of noise when you try to pull the tits out of their mouths too fast, and this recession is not about the chronically unemployed – who know the system and how to game it, it’s about virgins with high expectations, fixed costs and attitudes of entitlement born from permissive parenting – it’s different; it’s me – it’s a whole shit load of individual me’s, and all of us require a lot of lubrication before giving it up without kicking some balls and scratching some eyeballs out.

I’m not going to give excuses why people stay on unemployment, they all have their own motivations and fear, as I certainly do. There comes a time when you have to say that the dream is over, or at least on hold, and to find a job – any job, and to get back to work. If you have any value at all, and work hard, in a couple of years things will get better. It’s America and things will work out because they always do if you work hard.

That being said: there are a lot of people and businesses that suck on a lot of tits of entitlement that weaken them and make them less dependent on work and skill in this country, and it seems somewhat cruel to pick on people whose jobs were eliminated through no fault of their own and outsourced for profit to lower wage countries, but, I suppose, it’s a start.




  

Malise

Malaise

“We are at a turning point in our history. There are two paths to choose. One is a path I've warned about tonight, the path that leads to fragmentation and self-interest. Down that road lies a mistaken idea of freedom, the right to grasp for ourselves some advantage over others. That path would be one of constant conflict between narrow interests ending in chaos and immobility. It is a certain route to failure.” Jimmy Carter, 1979


    Nobody wants to hear the truth, it’s uncomfortable and forces hard decisions on people incapable of making hard decisions – how do you think we got in the place where someone had to tell us the truth anyway? Even when time has magically transformed truth into history, it’s only comfortable for most if changed and revised until it no longer looks like something we could have anticipated and done anything about – as if god alone were making the choices that led us from then to now.

    Thirty years ago we faced the truth and were offered a decision: To live within our means and accept individual limitations for the good of all, or, to make the little we had frothy, and live among the bubbles until they popped.

We chose Reagan, and from this first cause of a choice we are now living in the accounting time of the effect.

We saw our manufacturing leaving, and it left. We saw that Wal-Mart would eliminate high wage jobs, and now we can only afford Wal-Mart. We saw that dependence on foreign oil would lead to paying terrorists to bomb us, and they bomb us. And don’t forget the climate thing – the truth is out there and it has been for a long time.

 I like Obama – when he talks of financial reform or immigration, it’s with well reasoned and articulate words – and it rings of the truth. But I also liked Carter, for pretty much the same qualities, and he is not well thought of in any historical kind of way -- at a minimum, he had a failed Presidency. He was a loser, though I’m still his biggest fan.

Carter was also the most honorable and decent man to hold the office of President in my lifetime. I don’t know what this says about us, I don’t know what it says at all.

 I like to think that this time will be different, but it never is – it’s a loser bet to even hope that. And without the hope that our children will have it better than we did, there’s no energy for moving forward in any way that has real meaning, and I don’t see any hope of it. – Can anyone out there imagine that their child will have it better than they did during the Clinton years?

Oh, and I finally figured out why we keep increasing our troop levels in the mid-east – it’s a jobs program, because we couldn’t handle the 25% unemployment levels that bringing the troops home would cause. Nothing else makes sense.

   
   
  

Job Searching

Job Searching

"The threat is nearly invisible in ordinary ways. It is a crisis of confidence. It is a crisis that strikes at the very heart and soul and spirit of our national will. We can see this crisis in the growing doubt about the meaning of our own lives and in the loss of a unity of purpose for our nation." Jimmy Carter


    The candy dish on the receptionist’s desk was empty, just full of dusty balls of detritus that blew back and forth when the central air kicked on. This was useful in roughly dating the last time anyone filled it, or saw the point of filling it. 

Also on the counter were large, and hefty, prepared packets of applications – useful as an industrial and assembly line statement for those job seekers overconfident in the estimation of their worth. 

The receptionist, attractive and well dressed, had been reduced by the volume of work and was functioning as a human phone tree – catching key words to direct you to one place or another. Since there were only two places, extra friendliness was not appreciated – she frowned at any word not in the algorithm she was using as a sort of behavior modification warning shot, and the threat implied by her look was one of lost paperwork, or just a lengthy misfiling accident if you kept it up.


    Given a pile of stapled papers and directed to a long and well-worn table, I sat uncomfortably close to many others and started to fill out the forms. Most of the forms were about endurance – having enough of it to sit steady and enough to retentively write the same information over and over – many of the forms required that you reentered the things from the page before, and after a few pages, it seemed less like information giving and more just a way of weeding out the riff-raff, or those others with inpatient souls or those without anything better to do. It went quick – I had my resume and contact names typed up, so it was really just a fill in the blank drill done over and over. When finished, I returned the pile to the receptionist.


    At the desk, the receptionist was on the phone scheduling a person for a third interview. I was surprised, I’d never heard of a third interview for a security guard job, but tried to keep a blank face while I thought about it, and it did make me think about it. She hung up the phone and looked at me impatiently, but incongruently with a smile, and took my paperwork from me. After quickly scanning through the pile she pointed out a section I’d missed and handed the pile of paper back to me.


    I missed the essay section, but in my defense it looked more like a list of requirements, or maybe a statement of core values, than questions. Under each lengthy question was a small area to answer – the double part of a double spaced line to be accurate in size. There were five questions and I’ll give you what I remember of the first:


    “We believe that the most important value that our organization tries to uphold and live by is the concept of, ‘dare to be great,’ in all you do for the company, and in all your actions. We believe that in daring to be great you show the best that we have to offer as an organization. Give an example of a time when you ‘dared to be great.’”


    I filled out the questions to the best of my ability, as viewed through the whims of my nature, and returned the forms to the receptionist. As she took them from me, I gave her my best double dog dare to be great smile and left the building.
  

  

  


  

Fathers Day 2010

    When the kids were small, for shits and giggles, I’d pick them up by their ears. I’d look at them and say, “I’m going to pick you up by your ears,” and then reach down, with my palms facing their little heads, I'd then wrap my fingers around their ears and press my hands together, to squeeze them in a gentle vice type action -- and then I'd lift them up in the air a foot or two -- just enough to say I had.

    Allison knew from the start, and from an inner instinct she was born with, that the trick was to grab my forearms with her hands and to hold on tightly as I lifted -- to allow the grunting and flourishing that I was acting out to steal the show, while safely playing the straight girl, and to allow my dramatic showman's flow of personality to distract. I love her because she was in on the joke from birth – and she always will be.

    Kayla never knew it was a trick. She thought I could make the magic real and that everything I dreamed of could actually happen. She never grabbed my arms and never flinched away. She also never went too high, though sometimes I’d get her a foot or two off the earth before I knew what I was doing was impossible. She never got the joke, and I love the fact that she never thinks that there was one.

Two Funerals and a Cup

Two Funerals and a Cup

As I write this, little flies are bouncing off the glass door next to me, frantic to get out of here and away to something else, anything, else. They seem to be the same as the ones that were frantic to get in earlier, though, since they are flies, it’s difficult to be sure.

I’d like the power to dip them in amber to make them live forever and, maybe, make them be a little less anxious about what they are missing as they ram their little heads into the wall. I’d like the power to read them – to unzip their DNA in real time, to play them back in reverse until I understood what motivated and drove them, to gain a little fucking perspective. The only thing I can see now is that they eat shit and make more flies -- and I wonder if that’s the point, and if it is, why?

We are not movies, but we might as well be for all the acting we do living and dying from scripted cause and effect. And maybe it is all written and we are just playing out a strange combination of strings and boxes – and that life is just complex algorithms straightjacketed to physical laws that we play out like a meat DVD in a machine the size of a universe.
 
Because it’s becoming clear to me that free will is not about the choices you make, and your life, in the end, is only measured in the finite things you have done, not by your dreams or ambitions -- and when they bury you it’s with slide shows and spoken soft memories said out loud by people who only know the part you played in their lives. You are the stains you leave on others by rubbing next to them over time, you are the marks and scars you’ve left without thinking as you stumbled home drunk in the fog of what you thought you were. You are the sum of memories left in hearts and carved on walls, you are what you have left in others to hold of you through acts of laziness or purpose. You are what they take from your actions, not what you choose to give them from your dreams.

On Wednesday, I went to the funeral of my adopted sons mother. On Friday, I went to the funeral of a friend’s friend.

Ricky’s mom was not someone I ever really knew, though as Ricky said, if I knew him, I knew her. I think he was right and when he said it and in a way I did see her through him, but not in the way he thought or meant. I did not so much see her as I saw the influence of her -- I saw the shapes she had left and the curves she had molded in him. I saw softness, love and decency -- all things that he had to start with, but as he stood and talked to me of her I could see that some of these things came to him as a gift – that they were add-ons of depth that had come from, and been reinforced by, the way she had touched him as he was growing up.
 
The other funeral was for Martin’s dad – a friend of a friend for the most part, though I’ve been with Martin a few times and genuinely like him. Martin lived with his Dad, who was my age, and found him dead one morning for no obvious reason. The funeral was one of sadness and loss – lots of friends and family talking about fairly outrageous things his Dad (Gary) had done over the years. The impression I got was a man of many strong traits – both good and bad, and a father who lived for his kids. The slide show at the end of the reception was heart breaking – a summing up of a life lived loudly and with humor and the juxtaposition of being alive in a picture and being dead on a table was stark and dramatic.  When I left I told Martin that I was very sorry for his loss, and meant it in a profound way.

Both funerals started in funeral homes with religion. Both quoted platitudes from the 2nd Corinthians – that sales pitch section of the New Testament. Evidentially we all come from God and then go back to sit next to him when we die – presumably to talk about the lessons we learned and to trade stories with Jesus over drinks at a choice table shaded from the harsh brightness of light by a spiritual umbrella that’s provided by the management as one of many courtesies. I suppose it’s comforting to know this stuff, but find that getting comfort through willed ignorance is like thinking you actually get free money every April from the IRS, or slamming morphine to feel better about a broken relationship.
I’m not big on religion, but do agree that we come from something and go to something – I suppose it’s just the details that I disagree on, but cringe at the supposition that they have certainty when I have only best guesses. There’s nothing wrong with using the crutch of religion, but I don’t want to be beat with the absolutes of it when I’m sure they have less of a clue about things than I do. I don’t know what’s going on, but I’m pretty sure they don’t either – and black and white thinking is the refuge of idiots seeking shelter instead of understanding.

Religion is the cup referred to in the title of this essay, by the way -- in case my allusions are less than clear.

It’s tough to go to funerals of people you don’t know – it gives too much time to think selfishly. Not involved and emotional, and having no stake in the proceedings, it’s tough to connect to the person being remembered in other than an abstract way. It’s not tough to feel the pain and sorrow, but it’s tough not to but yourself in the place of the person being remembered and not think of yourself in their place. It’s tough not to think of your own inevitable death. It’s just tough.







   
  

Views from the Garrett

Views from the garrett

Boulder Utah

    I finished my five pounds of crap coffee this morning – a gift of something that might have been abandoned in the trash if not for my poverty – a gift given in a large plastic zip lock without label, identification or aspiration. Not wanting to go crazy by getting too ahead of my station in life and say, rocket up to something more substantial like Peet’s, I bought a pound of Mr. Coffee ‘Bold Brew’ with a plan to live with it until the next upgrade cycle – maybe then to switch to Dunkin Donuts, or something similar. It’s just a drug, and the dosage stays the same no matter what the taste – and I’ve forced down worse for less in my lifetime.

I ended up with the bag of crap coffee because Mary needed the can for medical reasons – to wrap a thromboemboletic stocking around the lip of it in order to allow her mother an easier way to put the damn stocking thing on her feet. (Get can, wrap stocking, insert foot, and pull stocking,) She dumped the coffee and kept the can – after drinking it for a month I can see why.

Just as traveling from one part of the world to another induces jet lag, abrupt transitions from anything to anything else induces a giggling paralyze in a person that confuses and angers the soul. This might explain class and caste, but I’m thinking smaller – that individual wanting or lacking that drives us to race franticly down roads, and off roads, into bushes and canyons of stupor and need, all in a search to get back to what we know, and away from all the weirdness of what we see as the new. Change is best when gradual – if it happens too fast it’s a mutation or a cancer.

You can’t throw a rich bitch into a ghetto without transitioning in a split-level ranch a few weeks without expecting hijinks to ensue and dogs of a special kind to be unleashed.

We started high and worked our way down. Vegas had dual showerheads, TV’s built into the bathroom mirror and buttons next to the bed to close the drapes at night. The air-conditioner was central and noiseless; the shampoos had French names and strangely shaped bottles. We were on the 18th floor and all was down. From this we went down.

We were on the top floor in Mesquite but it only had four floors. The shower had a fancy head, but only one of them. The soap was from San Francisco and smelled nice with a rich coloring, but the bottle was pedestrian. To close the drapes after all tucked in and comfy involved getting up naked and running across a freezing room to pull them shut. Nice, but not too nice.

The next night we were in Escalante – cinderblock walls, a Desert Sun brand of shampoo and a noisy AC unit that buzzed even when it was off. Thanks to a night acclimatizing in Mesquite, we were ready for it and slept like babies attached to the tops of lawnmowers.

We planned breakfast in Boulder, but I got coffee in Escalante before we started the drive at an outdoorsy shop that advertised espresso on a hand painted sign in the window. Served by an older thin and physical woman from a small home type machine in her kitchen I looked around the shop at all the wonders being offered up to enjoy the outdoors with. My last technical cutting edge moment was in the 70’s -- with Jansport packs and closed cell foam mattresses, so I was impressed with all the new stuff, though confused as to the point of some of it. I liked the coffee, and the concept of good coffee in the middle of nowhere.

As we drove off down highway 12 to Boulder, Mary read from a local rag that, “Bolder was the last city in the country to get its daily mail delivery by mule.” It’s also my favorite section of Highway 12.
It’s deceptive – you ease and slide your way through increasing slick rock, and random dips in valleys until, without notice, you find that you are driving along the crest of a mountain, with steep drops on either side of you. The thought, every time, is the same – I wouldn’t be doing this if I knew I was going to be doing this. It’s mentally a ridgeline asphalt hiking trail that we are riding on a jet packed set of roller skates. Mary’s hands are clammy, but I’m just amazed.

It’s less than an hour to get to Boulder and the turn off to Burr trail, where we eat, and I talk about what’s coming up. I feel like I’m progressively sucking her in to my plan to take her to the ends of the earth, and that it’s too late and we are too nowhere for her to back out. This is how people get into trouble I think – bad plans and an inability to bail -- or maybe it’s just the directions for the best way to cook a frog, but I’m thinking as I talk, have I learned nothing from eight years of Bush?

The Burr trail is 60 miles of back roads through the Capital Reef Park. The last time I came I drove it with Ricky in a four-wheeled jeep, but I remember it as easy enough and worth the effort. I wouldn’t drive it in the rain, but it’s sunny and, really, what’s the worst that could happen?

We finish eating at a great breakfast place without a name I remember (You can’t see it from the highway, but it’s obvious when you turn down the Burr trail, and less than300 yards from the turn off.) The servers are two Asian girls, and as I leave I wonder what they do for fun when they are not working. They don’t speak English well and seem very out of place – I guess very much like us in a big sense.

The first twenty miles are paved and beautiful. We first pass a RV park and then dive down a steeply curved road into a canyon. The roads not too scary, but I think to myself as I drive it that I don’t want to come back up it if I don’t have to.

The canyon is tall and red on either side of us, with small visible slot canyons cracked into it as we travel. The road is black and unmarked, and wide enough for other cars to pass, but narrow enough to pay attention. It’s quiet and ours, and this makes it the most beautiful part of the trip for both of us. It’s like Disney made a park for us alone.

After twenty miles the road changes to rough gravel, and after a few miles of rough gravel, the bottom drops out.

We have hit the switchback part of the road – the place where Ricky and I thought about bailing and going backwards to the paved road -- then back to the no-name restaurant for a late lunch. The road is gravel, big time steep and loaded with Bolivian type switchbacks. For some reason, it doesn’t look to bad this time, so without thinking about it too much, I head down. Mary kept her sweaty hands in her lap as I drove downhill in low gear, and neither of us looked out at the view or were tempted to stop for pictures.

At some point I turned to Mary and said, “I promised to take you the middle of nowhere and here it is.” Her kids thought I was bringing her out here to bury her, but that’s not my style and I didn’t have a shovel.

From the bottom, the next forty miles were empty and not much to look at. I couldn’t really look because the road was a washboard of dirt and I had to switch from one side to the other to keep any speed without the car shuddering to pieces. We headed north, or right, to connect to Highway 12 further down, though, if I had to do it again, I’d head south to Ticaboo, just to say I’d been there.
It was a long drive to the Highway and sort of pointless at one point. I worried about the shaking my car was getting, but occasionally a Hyundai or Kia would pass me going the other way and my cars Japanese pride would force it to behave more correctly and with less noise and so we continued for hours at low speed until we hit the paved road again.

On Highway 12 we went the wrong way on purpose in order to backtrack the ten mile to Fruita, an old Mormon town that specialized in growing fruit. We stopped at the visitor’s center and bought so taffy and apple butter from the Mormon’s and then headed down the road to Hanksville.

Tuba City

      It ended well: with us sitting in a nice Travel Lodge restaurant sharing a common meal of roasted chicken with a Harry Potter birthday party, but it didn’t feel good on the way to getting there. Arriving was the best part of the day.
    We had decided to head south from Moab -- rumor and deductive reasoning said the road would be pretty, and since it was new to me, a bit of something different to tell tales about to others. (When traveling, I tend to tell the same stories about each milestone on the trip. If you travel with me two times, you only get one story, so it’s best to seek out new roads – best for everyone.)
    We are headed south but it feels like we are just going down. To the right, uranium mining tailings and to the left, not much. There’s a big time headwind – I feel like I’m riding a motorcycle with a cracked windshield. The road just goes on – Monticello, Blanding, Bluff etc. We look for a place to stop and eat, but each town has little to nothing of interest. We stop and pee at a museum of something Utahish – we just use the restroom and don’t enter the actual museum. The wind blows grit into our eyes; the clouds are made of fine dirt.
    We give up our plans to eat at Mexican Hat and start eating taffy from the glove compartment. I stop at a Shell station for gas and cokes – bored and chubby Indians stare at me. I don’t ask for directions – it’s all too obvious.
    Leaving town, at the bridge over the San Juan River, we almost miss the abrupt left turn, and by some form of an accident, go straight into a roadside café/motel compound. We stop because it looks cool and funky, and because our expectations have been lowered, and because we are hungry.
    I have Indian fry bread with beef stew—the bread drips Crisco, the stew is a soup. I look over to Mary and see mustard, catsup and pieces of pickles plopping on a plate – I’ve never seen more of a mess around her. I look away, and then get up to look at the pictures on the wall.
    Most of the framed prints celebrate the new bridge over the river – they are dusty and forty years old. The old bridge had planks that you needed to line up your wheels on before you got on the bridge in order to cross without getting your car lodged unbalanced, and hanging on the wooden supports. Times have changed in Mexican Hat, but not much, and only once.
    We finish lunch and get back in the car to keep heading down. Through the dust we can see Monument Valley in the distance. It never gets closer, though we are traveling on the road that has its name. Evidently, and at some vague point not obvious, you have to get off the road to get to the valley. We admire the view from afar, but have no interest in trading delay for pretty. We are going down with the road in a depression of ugly – not much seems redeeming in any spiritual way in the things we see, and the wind continues to blow dunes of sand across the road to try and twist us off our path.
    We are headed to Tuba City. Mexican Hat had a rock formation that looked like a Mexican sitting with a hat on, so I look for a Tuba, but the land is flat – it looks like it was dug up, turned over, and then left in piles of uneven clods for the wind to turn into dust and blow away. It’s a drifty kind of country without form or function to nail it down.
    We arrive at Tuba City and leave it as soon as possible. Our only stop is to urinate, which I do quickly and then wait by the car for Mary to finish. A smiling but drunken Indian walks up to me with his hand out – to shake or ask I can’t guess, but don’t care. I tell him I don’t want a friend as I look into his eyes – he jerks into an anger and curses me while sizing me up. I’m steady and big and  he walks away while cursing me. I see Mary coming back and look around for the Indian to point him out to her – he’s gone, disappeared into the nothing – there is nothing around me to hide in – I’ve parked in a big plain of no thing, and he’s gone into it.
    The only new things we have seen in Navaho Land are the government buildings and the schools. All along the way we have seen abandoned double wides with windows missing, as if plywood and nails to board them up we either unknown or the concept unheard of. I hope the brand new schools have teachers; it will take generations to fix what I see around me. The government buildings just seem a cruel joke for people who have lost everything they believe in.
    From Tuba City, we dive to Flagstaff. After a few hours, we find we have ended up on Route 66 through osmosis or luck, and find a motel to stop for the night. We are exhausted, but head for dinner at the restaurant attached to the motel.
   
   
   
   
   
   
   
   
   
   
   
   
  

Seligman Arizona

Traveling west on interstate 40 from Flagstaff, we passed by Williams on the way to Seligman. We passed it because it doesn’t need our help – it has both pine trees and a train to the Grand Canyon to keep it alive, and though bypassed by the freeway, it still sits close to the road and is accessible to the casual tourist, or those in need of gas and candy.
Ash Fork comes next, 20 miles later. A crossroads for the turn south to Prescott, it’s not much, and is never a stop on any of my journeys. Someday I might find out I’d missed out on something nice there, but doubt it, and have no interest in it at best.
There is a new turn off a few miles down from Ash Fork – an exit with no other purpose than to get you back on Route 66 for a few miles. I’ve never seen it before, but it doesn’t look new. We take it, and as we parallel the interstate, I remember it as the place out car broke down years before – back when I was very young, and times were different.
This was where I rode the twenty miles into Seligman in the front of our station wagon as it got towed into town. I remember the thrill of facing down while sitting in the front seat as we were towed from the rear by a giant truck driven by big guys.
We were on our way to something new again – a new start in a new place, after giving short goodbyes to people and friends we cared about, and before we started again with the work of making new friends and adapting to new normal in another strange place. More lines to learn for another stage, all in an endless chain of play and pretend – that I was normal, and that this was too.
Seligman has not changed much -- maybe just the edges where the interstate connects it. Coming in from the east, I point out the motel where we stayed that week long ago – now under new management, with a Pizza house where the restaurant was and concrete filling the area where the pool was located long ago.
My brother and I hung by the pool that hot week and got burned and tanned. My mom worked on her writing in the room close by and left us to our own – and we took our freedom in this small place.
I don’t remember much about the week, just the freedom of the here and the now. No phone, no place to be, no address to find us, just my brother and I in a cold pool without end or purpose. Free from the pain of leaving behind, and free from the burden of joining again.
We pass the big blue motel sign and after a short mile, enter the town of Seligman itself. A short mile is still a mile – I remember walking it on late afternoons to visit from the motel – hot and sweaty, and anxious for cones of soft serve.
The Snowcap roadside café is still there – famous in Germany as a symbol of the strangeness of all things American and west. The old guy that ran it is dead now, his manic energy, probably pathological, is gone, and the place sits in the sun as an almost museum of the arcane. It’s eleven in the morning and is not open – no signs point to when it will open and the busloads of tourists wander around it taking pictures and using its outhouse to relieve themselves. Old Route 66 signs are hammered to trees and other signs are posted on anything that nails will nail to. The windows are lined with postcards from people who had visited here in the past and wanted to give their thanks. Doors open to nothing and all the lights are off. I remember the soft serve was great, but the old guy was strange and the walk back to the motel was long.
Another mile of Seligman, lined with stores set up to sell to tourists the crap and pomp of Route 66, and we reached the western edge of town – more functional with gas stations and eating places. We avoid the Road kill Café and eat at the place directly across the street – Lillo’s.
Lillo’s is a find – a really good place to eat that’s right off the freeway. Large, wood paneled and full of neat little touches, the food is great and the waitresses real. By our table is a faucet that runs continually into a pail of Corona’s and doesn’t appear to exit anywhere or fill up and over flow. A customer asks how this works, and a waitress guides him over to it and points out the mechanics. I turn my head away, I don’t want to know how the magic works, and I don’t want to see what’s behind the curtain, because I already know and don’t want to think about it – that’s not why I’m here and that’s not what I want to do.
We left town after eating, heading down the best part of Route 66 to Kingman. We passed the concrete remains of the abandoned repair shop that my mom had fought the auto guys over time and money. My dad was off fighting a war, and my mom was the family point guy for this thing in my life – this time without computers or overnight shipping. I think the parts to repair our car came by bus or maybe mule, but only knew that it always took longer after each talk she had with them, and that longer was always better.
I remember the night before we left Seligman, my brother left his back on the bed. Burned to a crisp, he took a fevered and unmoving nap, and when he got up, his skin remained on the sheets in a perfect outline of his body.








   
  

Something different today

I finished the first draft of book length memoir yesterday. It’s more than 50k words, and is printed and sitting on my kitchen counter.

I celebrated by going to Pollo Loco and having a dinner of grilled chicken, then stopping by Walgreen’s and buying a small box of Oreo cookies.

I ate the cookies, and went to bed early. 


Today I cut my hair, washed my clothes and got the oil changed in my car.


Who knows what will happen tomorrow.

Deadman, Chapter 25

Chapter 25

         I returned to Posey’s room and thanked the nurse who had been covering for me while I was out. She said, “nothing happened,” but I would have been surprised if she had actually done more than listen for the alarms.

         In the unit, we took breaks when we could – our relief was usually a nurse with nearby patients. Breaks were never long, the nurses that relieved us were just as busy and we were, and watching an additional couple of critical patients was sketchy at best. The charge nurse should have been out of care (without patients,) and available to give us breaks, but budget cuts had ended that practice earlier in my career.

         I changed out Posey’s linen again. It got less lumpy, and I satisfied a need for fetish. I looked up at the monitor and notice some changes in the shape of his hearts rhythm. I poked my head out of the room and asked the ward secretary to order an EKG for now. (I requested it, “stat,” but feel the word is overused, and am somewhat embarrassed to admit I even used it back then.)

         The EKG technician poked her head out of the room next to mine when she heard my request and looked at me, and then pushed her machine over to Posey’s room.

         The EKG showed that Posey was extending his heart attack.

         A 12-lead EKG is read in sections. Each section consists of three leads, and they follow the heart from front to back and left to right, showing what’s happening at each specific area of the heart at the time the EKG is done. A heart attack may effect the anterior portion of the heart – this would show up in the V3-V6 leads. A heart attack may damage the inferior side of the heart, and this would show up in leads Avl, V1 and V2. By knowing the leads you are looking at, you can see the damage that’s being done to which part of the heart.

         Posey had been admitted with a large anterior infarct. The EKG’s done up until this point all showed inverted T waves in the anterior leads. This was what was expected – after the death of an area of the heart, the T waves turned upside down. This was seen in Posey’s V3-V6 leads, and was consistent with all the EKG’s he’d had since being admitted to the unit.

         The new EKG showed ST elevations in the inferior leads and also in the lateral leads. The ST elevations were present in all 6 of the leads adjacent to the anterior ones, but the elevations were higher and more pronounced in the leads directly closest to the anterior part of the heart.

         ST elevations are an indication of oxygen starvation – ischemia – The areas of the heart next to the one that had died three days ago were now dying. If Posey had been awake, he would have been having acute chest pain –probably much like the pain that had brought him into the ER. Since he was unresponsive, the EKG was the only symptom to indicate what was happening – that he was having another heart attack. Because it was occurring next to the original attack, the term for it was ‘extending’ instead of ‘new’ -- much like we call it an aftershock for an earthquake that happens on the heels of a larger earthquake.

The EKG indicated that the rest of his heart was dying.

         I thought, “shit,” as I walked out to the nursing station. When I got there, I saw Dr. S sitting at the station and reviewing Posey’s chart. I told him that he was too late, that Posey was extending his heart attack. Dr. S looked at me and said, “let’s go then,” and picked up the phone next to him and called the OR. When someone on the other end picked up, he told them to, “be ready, I’m on my way with him,” and hung up.

         With that notification, we were now officially on Dr. S time  --a time of masterful brevity and dervish action. We both went to Posey’s room, and with the charge nurse, a respiratory technician, and a couple of additional shanghaied stragglers he’d rounded up on the way, we took apart the machines, placed the important things we needed for monitoring on portable monitors and headed out the door. It took less than five minutes to undo my days of work.

         I asked him if he needed a consent signed by Mrs. Posey and he said he had one, though how he had gotten it in the ten minutes I’d been away from her I didn’t know. We careened down the hall, him pushing, and me dragging the balloon pump machine behind him. The respiratory technician was bagging Posey with portable oxygen, and the shanghaied stragglers were trying to keep everything on or attached to the bed as we raced to the OR.

         When we reached the double doors that opened into the OR, a hall monitor stopped us – all of us were unclean, and access was forbidden. As the OR nurse shunted us off to the changing rooms, Dr. S pointed to me and said, “I need him,” and she let me pass, balloon pump and all, after slowing me down long enough to put paper booties on my feet, and to hand me a mask to put on before I traveled further.

         In the OR room: Posey’s bed was pushed to a padded metal table centered in a large tiled room -- even the walls were tiled. A nurse pulled one of the draw sheets underneath him up and to one side and a roller board was placed under it – then Posey was yanked to the table and the board was removed.

         Dr. S grabbed a squeeze bottle of dark brown povadine solution and, like a backyard grill master preparing his charcoal, spewed the solution in jerks across Posey’s chest, then wiped most of it off with a clean towel. He took a scalpel and slashed deeply into the midline of the chest, tracing the outline of the sternum, dipping the blade down to the bone of it. He picked up a medical version of a combination jig-saw/skill saw, turned it on (if it had a pull-start, I would have fainted) and cut Posey’s sternum lengthwise, and completely, into two long pieces. Grabbing the two-piece retractor set, that was connected together after being placed on each side of the chest to form a spreader – He cranked the chest open with a ratchet wide enough to set a dinner plate on, or four big and active fists.

         With the chest open, and exposed by the deep cut he had made, Dr. S slashed a line across the pericardial sack and opened it up, then cutting it back to the edges of the opening and dropping the skin of it into a basin offered by the scrub nurse. The heart now exposed, he stuck his left hand in to do internal cardiac massage and to get a feel for what he was going to have to work with.

         From the time Posey hit the table, all of this took longer for me to write than it took for him to do. As Dr. S worked, the rest of the room was frantic with semi-controlled movement as well. It was like structured chaos in the room, there were patterns but they were complicated and hard to differentiate from the random.

         I found my tubing, and the wall outlet, and restarted the balloon pump. Two scrub nurses set up large flat tables on either side of Posey, and laid out instruments and tools, the perfusionist brought in his by-pass machine and continued the process of setting it up, the anesthesiologist gave Posey injections of narcotics to take him even more under and out, and running around like a crazy person, the circulating nurse circulated and made sure everyone had what they needed to do what they needed to do.

         This was my first time in the OR since I’d left it years earlier (after my short career as an orderly.) I recognized the pace of it, but still was just getting impressionistic snap shots of what was actually going on around me. I could break down the generalities of things – He does this with that, the next step is, -- but not the skilled parts of the action – the special tools, the specific sutures to be used, the learned order of events trained over time. But the pace I understood – it was fast.

         Dr. S continued massaging the heart with one hand until Dr. R arrived, cleaned and scrubbed, from the anteroom, and took over the massaging. S then left to get properly scrubbed and gowned for the procedure.

         The heart uses a tremendous amount of energy – it has to contract 80 times a minute, every day, for a lifetime. The heart is supplied the oxygen it uses for the energy by arteries that run across it and around it. The arteries get the oxygen through the blood that comes through two openings in the aorta, just above where the aortic valve opens.

         One opening goes to the right side of the heart – the right coronary artery (RCA). It supplies a large area, but since it’s mostly for the low requirements of the right side, it’s sort of a backwater for concerns and attention.

         The other opening is for the left main artery – this is a short fat tube that almost immediately branches into two other arteries – the left anterior descending artery (LAD), and the left circumflex artery (LCX.) These are the biggies for heart flow.

(People truly are different, and sometimes the RCA is the major artery, and sometimes they are born without parts of the arteries—and sometimes they have extra arteries. It’s hard to know for sure until you look.)

         A heart attack happens when a clot obstructs one of these arteries, or the one of the arteries gets too narrow to allow blood to flow past it. By-pass surgery is when you take a vein and attach it to an area where the blood still flows – above the obstruction, and then pass the vein over the area that’s blocked, and then attach the other end of the vein to an area that doesn’t have a blockage – somewhere below the obstruction.

         To do the bypass you need to stop the heart in order to tie the knots -- the hair width sutures, the dozens of sutures – on both ends --one end of the vein to the artery, and then the other to the other end.

I’m talking very small sutures that are connecting a high-pressure tube to an active pump. It’s harder than it sounds, no matter how hard you think it sounds.

When you stop the heart, you need to continue to supply blood to the rest of the body, so you by-pass the system with a machine that pumps blood for heart while it’s in the shop. A perfusionist runs this machine, which is large and bulky and looks like sometime on the ban list for exporting to unfavored nations. The machine takes on the role of the lungs – it adds oxygen to the blood as it bypasses the heart.

         When Dr. S returned to the room, he took the large cannula’s offered by the perfusionist and stuck one in the arterial side – in the aorta above the heart, and the other in the vena cava, below the right side of the heart. When the perfusionist started the machine, the blood started to flow around the body, but minus the action of the heart. (I had stopped the balloon pump when the perfusionist handed Dr. S. the cannulas.)

         Dr. S stilled the beating heart with an iced solution of saline and minerals – to cool it down and to stop it from contracting. When the heart stopped moving, he started digging though the yellow fat that covered the heart to find the first artery that he wanted to bypass. He started his digging around the mushy part – the dark blue of damaged areas, places obviously dead and necrotic, and the areas right next to them.

         The veins for the bypass were being removed from the legs. As Dr. S worked the top half, a elderly old-timer surgeon made long incisions to the inner parts of the thighs and removed pieces of the saphenous veins – placing them in a basin of salt water for Dr. S to use as tubing for the bypass.

Not technically difficult, harvesting the veins paid well, and the cardiac surgeons gave the job to old mentors and other potentially useful doctors out of tradition, and as a sort of homage to the early adopters of thoracic surgery – those old doctors who, when faced with unemployment due to a cure for tuberculosis, found another outlet for their skills – open heart surgery.

         Dr. S, with Dr. R holding it in place, took one end of the supplied vein, and using a microscope placed over the retracted opening of the chest, starting tying the vein to the artery. Each connection took dozens of micro sutures, but each took Dr. S only ten minutes to tie them together – he was very fast and accurate.

Having identified four blockages that he wanted to go around with the new veins he had, it took less than an hour for him to find and then finish the work on them. The only words I heard him say during this hour, that consisted of more than three consecutive syllables:

         “This is like sewing wet tissue paper together.”

         When finish with the last suture, Dr. S took two paddles from the tray of instruments next to him and had the circulating nurse connect them to a defibrillator. Placing one on each side of the heart, he shocked it. He shocked it again, and then he shocked it again. After the last shock, the heart started beating, weakly and without force—it sort of quivered with regularity.

Many times after heart surgery, the heart acts like it’s stunned for a while, like a fish kept too long out of water, so we all stood there and waited for the heart to come to its senses and gain enough strength to rejoin the body.

         We waited.

         Once, when unemployed, I’d scheduled a job interview near my house for noon. At ten, I started watching a movie about an alcoholic, planning to watch only until he saw the light and got into recovery. Fifteen minutes before my interview, he was still drinking. Five minutes before my interview, he died -- drunk and alone, with his body resting near a dumpster. He never got it, and I missed my appointment. It was that kind of waiting.

         After a half hour, most of the people in the room had drifted off. Dr. S asked the perfusionist to turn off the bypass machine and removed the cannulas from Posey. The heart continued to beat, but without enough force to give a blood pressure to the rest of the body.

Dr. S removed the sutures attaching the balloon pump to Posey’s groin, and pulled the balloon out of the artery. He asked me to hold pressure at the site, which I did.

The scrub nurse that had remained in the room then pushed the two large trays of instruments away from her, and laid out a few items on a smaller tray and scooted it nest to the table where Posey lay, then took the rest of her equipment and left.

         After an hour, Posey’s heart stopped. Dr. S did not try to restart it. Taking wires from the small tray, he attached them to a needle holder and pushed the wires through Posey’s sternum to tie the bones back together. When he finished, he asked me to clean up, and left the room.

         In the end, I did the things that nurses are always left to do.  I removed all of the tubes and lines that were attached to him. I held pressure on the places that leaked, until they didn’t leak. I got warm water and towels, and used them to wash his body until it was clean again.  I walked out of the room and got a gurney, returned and rolled him onto it, and then covered him with a clean white sheet.

         I felt no goodbye, and sensed nothing from him. I left the room with only my memory, and only a prayer that the memory would be good enough.        

        

        

        

        

                   

        

        

         

Deadman, Chapter 24

Chapter 24

         There was a lull at the change of shift, as if we had decided as a group to pause and take a deep breath. The nurse I had relieved four hours earlier finally had time to give me report on Posey, though it was little and late, I appreciated the effort. Her night had ended brutally, with the death of a youngish open-heart patient, and her report was more about her than Posey.

         To talk about the things in your head is to set them free. But as a nurse, it wasn’t that easy. Spending the day juggling facts and feelings to construct a reality of absolute control was not something that just fell out of you at the end of your shift, and the subject matter of the actual work itself was not a thing to casually bring up at home with the loved ones. Shit, piss, blood, pus, and death were not things we replied with when someone asked how are day went.

         Some of the devils in our heads came out in work, through black humor and cynical jokes, and sometimes we got together as a group outside of work and drank a lot. As a rule, most of us did not talk enough. The more tightly the feelings in our heads were bound and wound by the science of facts, the harder it was to get them out by talking – it took longer because the work itself made the binding of feelings necessary to our beliefs.

         Talking got the inside out, but without a lot of talking, the inside things couldn’t get unwrapped enough to become available for the senses to sort through. Without enough talk, you just got the excuses, justifications and cover-ups. You got bundles of feelings spewed out in short bursts, all mixed up with motivations, directions and other crap. Only lots of talk allowed the time necessary to find the nuggets of feeling that accidentally got uncovered with the catharsis of throwing words about work up and out, and only time allowed some of the real stuff to stick.

         You’ve got to talk and get it out or it will start to kill the part of you that you needed to connect. But few want to listen, if you bring up digging out someone’s impacted bowel with your hands clinches the hard stool as you removed it, or dealing with a mother who has lost her daughter -- others would just flinch from the sound of you, and roll away as if they had wheels instead of feet.

         Nursing is not normal work, the hours are strange and the work consists of doing things that repel – things that you spend long childhoods learning to avoid -- like hot flames, or men wearing pinky rings. To be a nurse is to always have a head full of incongruities – you do things that you know are abnormal and wrong and you are exposed to the rawness without being allowed to show the weight of it as you walk around. When you try to shed it, you find yourself surrounded by walls without doors, peopled by creatures that most resemble rubbery obstructions from a bumper pool table. Every attempt to connect just bounces you across the table and into something padded but hard.

         It’s hard to get enough out in appropriate ways – The job is too much, no one is built with enough outlet valves to drain it, and few have enough capacity to store it – even stuffed real tight and shoved down deep, it leaks out.

         For many of us, drugs help with the stuffing. It was hard to work around drugs everyday, and to see them help others deal with catastrophes and not think it might work for you. They didn’t fix anything, but functioned like a pile of bricks on a stack of newspapers – they weighed us down and kept the wind from blowing us away, as long as we were careful and got the dosage right.

Drugs had side effects, and cost the ones who used them maybe more than they could afford to lose, but we were not cows, and were not designed to carry the weight we were asked to carry without end, or, at the least, occasional relief.

I’d been avoiding Mrs. Posey since I’d come in that morning. I wasn’t sure what to say to her, and didn’t have it in me to face her needs. I took the lull in the unit to walk out to the waiting room to find her.

I found her on the phone talking to her kids. She looked old, her hair was pasted to her forehead, and she was without makeup -- she looked like an elderly woman waiting for death to catch up to her. As I walked over to her, she said a short goodbye to the phone and hung up, then clasped her hands together on her lap. I sat next to her on a plastic chair and said nothing.

After a pause, she said that she had talked to both Dr. Lee and Dr. Cat earlier, and that she had not been encouraged by either. As she said this to me, I sat still, but my head was racing. There was defeat in her voice, and though the words were not clear to me, the substance in the tone of it was.

As a nurse you develop a relationship with the family – sometimes it’s the only real contact you have with your patient – since many times they’re obtunded and beyond caring by the time they get to the unit. Part of the relationship is about communicating and the other part is about guiding.

Back then, to most people, hospitals were like great and old Catholic cathedrals run by priests that faced away from them (towards god) and read the magical words of redemption in Latin from a book transcribed from another dead language (Greek.) The job of the nurse was to serve as a knowledgeable, but not too stuffy, parish priest as you explained the words and gestures, and, in general, act as a translator for the gods and rituals of medicine.

The relationships you developed as a nurse with patients and their families started from interpreting what was going on around them and, because of this, the initial conversations were usually and necessarily one-sided. It’s almost impossible to imagine either being critically ill, or having a loved one hospitalized and dying --usually it’s something that you get thrown into, and not a choice done after reflection and careful planning.

And once you are in the hospital, you are in a machine of complicated parts and unpronounceable words – all new to you and beyond any stability of understanding – you really are in a cathedral of death, as practice by people without a religion that gives you comfort. And the only faith you can see and touch comes from the nurse and the way that nurse carries herself as she preached to you her understanding.

Decoding the mystery of medicine was the basis of all relationships you developed in the hospital. But back then, it wasn’t enough to just explain, you also had to guide. As a nurse, you were expected to give direction, and to voice best choices to your patients. There was no marketplace of ideas for patients to choose from – they’d never been in this market before, and the ideas that were being sold were all written in a language they didn’t understand. There was no google to search, or simple answers to be found in magazines – medicine was top down, patriarchal, and very user-unfriendly. Patients didn’t even understand that, for them, doctor’s orders were merely suggestions, without any rule or law to command enforcement or penalty for rejecting them.

Our job was to guide our patients in their choice of treatments, to weigh and measure them, and their capacities, and to then judge what was best for them. When finished with our evaluation we were then to tell them what to do in a way that allowed them to think they were in control and making the decision. Our job was to give to the patients and family the illusion of free will, while actually practicing a limited form of predestination.

To be a good nurse you had to do these two things: simplify the complex and guide decisions. Nurses care for the sick – and this is how we define care.

Sitting in the waiting room with Mrs. Posey, I was of two minds – each with a though and each with a plan.

The mind that had gotten me through life up to this point wanted to tell her the truth – that her husband was dead, and that it was now time to say goodbye. The thought was simple, and it came complete with a plan to soften the words and make them more gentle than simple.

The other mind wanted to do something – anything. The plan was even simpler than the thought – by-pass surgery.

I made a decision, and began to guide Mrs. Posey towards it.

It’s our minds that we use to create the shell of ourselves that we show to others. Off this shell, we project what we want others to see, and then call it by our given name. Driven by fears, and the ambitions of fear, we hide what’s inside us, afraid of what it might do if allowed to play in the light. We make wrong choices based on want, and do what we know is wrong based on fearful wishes -- by blinding the sight of what we know is true on the inside.

A shell works both ways, and it’s hard to know what a man will do until he’s facing a choice he doesn’t want to make, with consequences he doesn’t want to live with. Heroic poetry is written for the man who chooses well, and tragedies about the ones who don’t.

Most of us create our outside as the vision of a Mother Theresa nursing kittens -- with both kindness and breast. But underneath this thin eggshell veneer of the civilized, is the truth -- we are all just Nazis waiting for the train to show up. As the Jews know, but seldom talk about, the best of them did not survive the holocaust – those without the skins of an animal to drape around their insides  – those with pity, compassion and decency, were all left to melt in hot furnaces, leaving only ash for the wind to scatter.

We of the western mind do much of this with death. We not only don’t value what it brings to the table – we penalize it and make it sit in a corner facing the wall. We apply to it the same standards of adversarial debate that we apply to the law – on one side we put medicine, on the other death, then we only allow medicine side to argue – and shackle death to a chair with a gag in its mouth and a bag on its head. We do this in apparent blindness to the fact that death always wins – all of us die and are no more. We can delay things, but honestly, the Governor is never going to pick up the phone and call.

Other cultures embrace death, feeling that the lack of it would be like the lack of clouds in the sky. Others say that only by coming to grips with the fact that we are doomed to death allows us to appreciate life – to live is to die, they say.

But as comfortable as I am with this knowledge, when the last breath comes to me, no matter how much I’ve prepared for it or how much I understand about it, I think my last request will be for more.

In the end, my decision to Mrs. Posey was driven by this thought. Not reasonable, the decision was selfish and motivated by fear -- I chose to do something because I was afraid not too.

What I was afraid of is what everyone is afraid of – death. To leave what I am for oblivion seems scary – where do I go, if anywhere? What awaits me at the other end? How will I be remembered?  –  And in the end --what mark have I left to find my way back?

I take some comfort in what Carl Jung said, “It’s not a question of where do you go when you die. The real question is: Where were you before you were born?”

I’ve come to believe over the years in a spark. In myself there is an irreducible piece of me that has transcended the events and the years that have passed in me. It is the piece that has remained the same and constant, the thing underneath all things that I call myself. Whatever else I am – a father, a son or a piece of meat that breathes, I’m this -- and I don’t think this can die.

I chose to guide Mrs. Posey to by-pass surgery for her husband. I did it for the wrong reason, though only my insides were aware of the motivations at the time. I believed in a small part of my head that there was a chance of it working, and then I built up that small part until it was big enough, and ran with it.

I told Mrs. Posy that it was a good thing that Dr. at refused to do the surgery, that it was a big and complicated procedure, and that Dr. Cat might not have been technically capable of doing it. I told her than another cardiac surgeon – one that I highly recommended, was on his way, “as we speak” to evaluate her husband, and that I would do what I could to make sure he was the one to do it.

Feeling better, in the way that a hard decision put off for later felt better, I left Mrs. Posey, walked down the hallway and returned to her husbands room.

 

                 

        

         

Deadman, Chapter 23

Chapter 23

         As people streamed into the room to help with the code, Posey’s heart monitor changed from ventricular tachycardia to ventricular fibrillation. The monitor bonged more rapidly with the change in rhythm, and the numbers began to flash red with each bong of the alarm – to show to the senses an elevated urgency.

         Ventricular tachycardia was a bad rhythm, but at least it was organized and trying – ventricular fibrillation was just a bag of wormy muscles just trying to get out of the bag to run amuck alone and without a plan.

         The treatment for both arrhythmias were the same – shock and awe, better living through electricity.

         Just as the heart is divided left and right, it’s divided up and down as well. The upper chambers of the heart are the atria’s, the waiting rooms. Low pressure, and fairly thin walled (left thicker than right) they are the areas where the blood pools before getting passively sucked, through the opening and closing of valves, into the ventricles -- which then do the actually work of pumping – or contracting.

The sino-atrial node is where the pathways that conduct the electricity that’s used to initiate the contraction are located – it’s between the upper and lower chambers. When the impulses that go up get irritated or blocked, you get atrial arrhythmias -- when the pathways that go down get irritated or blocked, you get ventricular arrhythmias. They are both caused by the same kind of problem, but the consequences are much different.

If you lose the function of the top chambers of the heart – the atria – you lose up to 20% out the output. If you lose the bottom chambers, you die.

Ventricular tachycardia after a heart attack usually happens because of irritability – the leaks of acids and other poisons from the dead areas of the heart cause inflammation and irritability, making the trigger threshold for ventricular tachycardia low.

Imagine the heart as an organized group of drug addicts – all in acute withdrawal. The addicts are all lined up for a race, and all scheduled to start when the green flag starts. The prize for winning the race is a bag of dope.

It’s that kind of irritability – and individual muscles either irritated by leakage or just poisoned by floating debris, tend to jump the gun and the race from an organized starting point becomes a free for all. But in ventricular tachycardia at least most of the muscles are aiming in the right direction.

Ventricular fibrillation is like that, but everyone’s a winner, and they get the bag of dope before the race starts, so when it starts, no one can know which way they might go.

Electricity, though untested as a treatment program for drug addicts, works wonders on heart muscles. Like a cattle prod, it gets their attention and allows them to take a time of quiet, stunned reflection and then restart in unison as a happy and coordinated whole. Make no mistake though, they may be lashed together and working as a chain gang as they contract, but they are still individual cells that are mighty pissed off.

Posey’s heart arrhythmia was approached in two different ways. I immediately got the defibrillator charged to its maximum, and after spreading conductive gel on the usual spots on his chest, I shocked him with the paddles three times in rapid succession. After each shock, I checked the monitor – after the third shock, he converted to a normal rhythm -- although it was still crazy fast.

Another nurse gave him an IV injection of Lidocaine, while still another mixed up a solution of it and hung it from an IV stand and plugged it into a stopcock connected to the central line.

Lidocaine is a member of the ‘caine’ family – you may know other members of the family better – Cocaine and Novocain. All of them work the same, though some are more fun than others. It’s all about side effects.

Lidocaine numbs things up, and when given internally through an IV, it numbs up everything it comes into contact with. When it gets to the irritated parts of the heart, it numbs them up as well. The cells are still irritated and pissed off, but stop complaining because they can’t feel anymore.

There are side effects – sometimes it numbs the brain up as well and makes people stupid, and sometimes, when the levels get too high, it becomes toxic and starts killing the cells instead of numbing them.

And, it’s a cover up – it doesn’t fix anything, it just hides it, and when it wears off, the problems it was covering up roar back with a vengeance.

When the rhythm changed after the shock (defibrillation) the other nurses and doctors who had come in for the code began to drift off. The Balloon pump began hissing again more regularly and the franticness of the monitors alarms and flashing lights dimmed. I was left in the room with Dr. Lee, and a big mess.

I stood there and considered things. Posey lay in front of me on the bed, motionless and covered with goo. Blood was splattered in small splotches, and all the splotches could be traced to different causes. His heart rate was 120 beats a minute, and his blood pressure was 90/40. He had no spontaneous breathing – the ventilator was doing all the breathing for him. Hanging from his central line were medications – all maxed out at their maximum dose, and as I looked at them, I could think of nothing more to add that would help.

I stood there and looked at Posey and had a moment of clarity. I had no idea what to do next.

Without the clarity, I would have started something – cleaned him up, adjusted the lines or documented events in my notes. In the clearness of the moment, I found myself seeing the big picture – that it was over and that he was gone, and everything I did from this point on was just going to be a mechanical grinding – a going through the motions movement of wasted time, and compulsive busy work to keep me distracted and unfeeling.

I’d like to say that this made me do something I didn’t do. I’d like to tell you a tale of acceptance and loss – that I used the moment to reflect on the man who laid in front of me, of his life and the loss of it. I’d like to tell you I said goodbye and left him go.

I turned to Dr. Lee and said, “How about Dr. S. – is he available?”

I remember that Dr. Lee looked at me in the same way that I had just finished looking at Mr. Posey. You could see in his eyes that he was having his own moment of clarity, and that this clarity was about me. In that moment he was having a complete change in how he saw me – my motivations, fears, and seriousness. He saw that I not only cared, but, perhaps, that I cared too much. In his eyes, I saw that the thought seemed repellent to him.

Our relationship, Dr. Lee and myself, was based on distance. Neither one of us got too close to our patients, we both maintained a distance from them, and we both felt that our real skills came from maintaining this distance. Lee knew from his experience with me, that I could walk away from death without looking back, and that my caring ended when I walked out of a patient’s room to go home at night. He knew that I showed neither empathy nor sympathy for my patients, and that I treated them as a professional, and not a friend.

When I asked him about the availability of Dr. S., he knew what I was really asking – for him to call Dr. S and get him to come in and do something – something interventional – something surgical and drastic. I was drawing a line and asking him to step over it with me.

Dr. Lee looked at me for a long minute, then turned away and picked up his lab coat from the linen holder, and walked out of the room. He didn’t say anything to me as he left because he didn’t need to. I knew he would make the call.

Dr. S was a cardiac surgeon who worked with another cardiac surgeon, Dr. R, in a two-man practice that contracted with several hospitals in the area.

Dr. S was from Australia, and was obvious about it. He was what I called a slash and burn surgeon – the best kind as far as I was concerned. He saw things simply, as problems and solutions – you saw the problem then applied the solution. He saw no complications – he was too busy addressing problems.

And he also had a cute way of using the word ‘mate’ as a pejorative, and was married to a beautiful nurse who treated him like something found on the bottom of a shoe.

His partner, Dr. R, was from Texas, and gay. Dr R walked, talked and wore boots like a Texan. He also flirted with the female nurses shamelessly, like all surgeons are wont to do, but always stopped before sneaking away with them for torrid weekends of sex and other thing’s debauched. He was as big as all of Texas, except for the gay thing.

The fact that S was a cuckold, and R was gay, were not something any of us on the unit talked about, except in whispers and giggles when they were not around. Back then, neither of these parts of their personalities were considered fashionable or trendy, and if made common knowledge they would have severely impacted their ability to practice their skills or make money.

Both of them were good surgeons – fast, meticulous and detail oriented, all things you want in a cutter. In cardiac surgery, you wanted all three skills, but speed was the key. Both Dr. S an R got in and out quick, and their patients did much better because of this.

When I asked Dr. Lee about getting Dr. S to see Posey, I didn’t do it randomly – he was the guy I would have used if I need surgery. I wouldn’t want to sit around a room and discuss great literature with him, unless we were drinking, but, like a master mechanic, he had the goods when using his hands to speak for him. He was an artist in the operating room.

There were other cardiac surgeons that I worked with that didn’t have the goods. Dr. Cat was one – he had sausages for fingers, and a brain that ruminated on several levels of meaning before instructing his hands to move. He was slow and clumsy, and these things were not attractive in a cutter.

Dr. Cat was a great talker and teacher; he would spend hours sitting at the nurse’s station explaining the latest in medical thought. Most of his talking came in the form of lectures, complete with footnotes, pauses and summary statements, but it was all interesting stuff, if that was what you were interested in.

When I first heard the word pedantic, and then looked it up in a dictionary, I thought of Dr. Cat – but with affection, not derision – He wasn’t phony with his talk – it was clearly the way he processed thoughts and organized information.

I liked him, but hated taking care of his patients after he operated on them – they spent too much time on the by-pass machine, and leaked too much after coming back, because Dr. Cat tied poor sutures with his sausage fingers and took too long when doing it. A great person but a poor surgeon – he needed to focus on things that involved more talking and less cutting.

There were other cardiac surgeons available, but all had weaknesses, and none had popped into my head when thinking about Posey. Dr. B was female, and you just knew she had to be good to get where she was, but had an unfortunate combination of attention deficit disorder with obsessive-compulsive tendencies. She was also slow – molasses slow, and had yelled at me more than a few times, when yelling at me once would have been too much.

Dr. M was adequate – he seemed up to date with his knowledge, and used all of the latest and best techniques, but his patients all did poorly for some reason and I had my doubts about him because of this, and the way his eyes looked at something distant when he talked to me.

When you got Dr. S, you got Dr. R with him – they worked together like a well-oiled team. The only time that you got one without the other was when they took call at night – one would be available to answer questions, while the other did whatever they were rumored to do, in the privacy of their own, and expensive, home in the foot hills.

They were like the cartoon classic, Heckle and Jeckle, when together. You knew abstractly that they were different, but couldn’t tell which one was which when they were standing next to you. They had different personalities, and each took different roles in the conversations they were part of, but it was never clear who was who or what was what. They fed off each other in this way – completing the others jokes, cutting what the other held out to be cut – all without asking or apparent discussion.

I knew that Dr. S had several patients on the unit – one of them had coded a few hours earlier when I came in. I figured he’d be in to see Posey fairly soon, and spent some time trying to figure out what I’d say to him that would make the difference. Without surgery, there was no hope for Posey, but I kept telling myself that with surgery he might have a chance.