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.