I drove home in the dark and parked my car on the street, as was my habit. My wife and daughter met me at the door as I entered the house, and after a hug from both of them, I went to the refrigerator and picked up a beer from the lower shelf, opened it with a twist, and started drinking, as was my habit.
I was drinking Lucky Lager back then – 11 oz bottles that looked like they had been made in the war -- some old war that nobody cared about or remembered. Under the cap of each bottle was a cryptic, sign language quote or saying -- done in pictorial stick drawings, with plus signs to indicate connections – they might have been meant as short essays for drunks, or served as warning notices for other peoples, those limited in attention and those not driven mad by unclear portents.
I had stopped reading the caps by then, too much trouble and no longer fun to figure out. I drank for effect --the cheapness of the bottle, and what they contained, was more important than any brief instructions that could be obtained from the signage on the outside.
I wasn’t a social drinker, but I wasn’t a drunk either. I drank for effect – for sleep, or to shut down my thinking -- which I considered the same thing. I never went out to have a drink with buddies, if it were just for fun, I’d rather have a coke.
But I wasn’t in control either.
After watching a sit-com with my daughter – me in a big recliner and her sitting on my lap snuggling, I put her to bed, went to the bathroom and pulled out a half full syringe of Valium, unscrewed the plunger and drank the contents from the barrel. I returned to the watch TV, finished another beer and then went to bedroom to get some sleep.
A line was probably crossed, but it wasn’t clear to me at the time, or for a long time after. Taking home leftover drugs and using them was not normal behavior, though it seemed so at the time – what was I supposed to do, waste them?
I may have seen the line I crossed in a sense – it was pretty obvious, but as any drunk driver going the wrong way on a freeway knows:
Bot’s dots, when seen going backwards against the flow of traffic at night, line the road with red, not white, as they reflect off headlights – The traffic bumps no longer serve as guides on a path, but have become warnings of impending doom and stupidity.
You might notice the rhythmic flashing of red as your car speeds steadily down the freeway against the traffic, and even comment on the strangeness of it, if only to yourself. You can see what’s happening, and even count the bumps as they pass you, but you aren’t capable of understanding the meaning of their redness, or of how you got there, or why you should get out quickly -- the consequences in other words, until smashed and damaged, you cry like a baby at the getting caught of it all.
I could see the line, but had no vision of what it meant. I was in the now, but not the now of the Buddha, but the now of obliteration into obliviousness.
I started using drugs when they first became available to me – it was never a question of whether or not I would, it was always a question of when. I smoked when I could get cigarettes, I drank when offered beer, and used drugs when they were available to me. I never thought of it as a question of choice, only as a question of dosage. I used whatever I could to change the way I felt – sometimes easily, in the simplicity of books, and other times with the harshness of pain. Tools, dosage and escape -- the trinity.
It was simple and unquestioned – I didn’t like the way I felt, so I looked for ways to change it. Like I said, life was about dosage – getting the numbers right.
I grew up in the right age for this kind of thinking, and found it easy to surround myself with others with the same goals. But, although no big punishment of awakening happened to me – no arrests, or the loss of jobs -- living as a casual abuser of drugs was limiting, and as I aged and took on more responsibilities, I was not prepared for them, I’d never done the practice work of being uncomfortable.
I became more workmanlike in my drug use as I got older, usually with alcohol and sedatives – things that made me feel normal, and things that slowed my thinking down enough to allow me to get some sleep.
To be honest, I didn’t think about it – drugs were just a part of the spiritual toolkit I used, one that I had to keep secret for legal reasons, not moral ones.
I reasoned, if I bothered to think about it at all, that if I told someone what was going on in my head, they would have seen the need, and given me the drugs – I was just removing any of the moral dilemmas that could come from the asking by taking care of it myself. It also occurred to me that if I said anything to anyone, they might want to fix me the hard way– and that was not a thing I imagined as a survivable event.
I look back on the person I was with regrets, but also with understanding. What I did for the reasons I did them are unimaginable to me now, but they were real, and I still bare the scars of them.
I slept like the dead.
Evidentially, the phone rang. My wife nudged me awake by kicking me a few times, and then handed me the phone, “It’s the hospital,” she said.
I answered by talking into the handset, asking what the time was. My wife said, “too early,” but the voice on the other end of the phone said three.
“Can you come in, now?” asked the charge nurse.
“Yes, as soon as I can wake-up,” I answered. I didn’t ask her why she was asking, and she didn’t tell me.
My wife was up, so she made me coffee while I showered. By the time I got toweled off and dressed, she was back in bed and asleep. I loaded up the travel mug with coffee and drove to work.
After parking in a doctors slot near the entrance, I went though the double sliding doors of the ER, and after showing my badge to the off duty cop, cut through a maze of gurneys and headed to the forth floor.
It was a zoo in the unit, and feeding time as well. I found the charge nurse going from room to room with a large garbage bag, picking up the big pieces of trash from each room, and then moving on to the next.
Three patients had crashed shortly after midnight, and two of them were still in the processes of resuscitation (coding,) She told me to pick up Posey for now, and to get report from the nurse I was relieving when things settled down. I saw Posey’s night nurse in one of the room where a code was taking place and yelled at her that I was taking over his care.
Posey was just as I left him, only trashed. The bed was covered with spots of blood; the tubing from the ventilator was loose and not connected to anything – and was alarming shrilly. One IV controller was beeping that it was empty, and it wasn’t, and another wasn’t beeping and it was empty – air was backed up in the line almost to the hub. The Swanz-Ganz reading was mushy and needed attention – the numbers were crazy, but not crazy enough to be true. Everywhere was mess and everything was stained and all was sticky to the touch.
I started by picking up trash in an attempt to uncover things.
I did not leave my patients clean and their equipment organized because of some built in and innate sense of order. I did not do it because it was easier, or because it made other people happy. I did it because the pain that happened if I didn’t do it hurt a lot.
I’m not rewarded by the pretty; I’m punished by the ugly – that’s the simple lesson for understanding my motivations.
Most of life is about getting presented with something and then doing something about it. When it’s over (the Lesson,) you then do a critical review of what went right, and what you would do the next time to make it better (the Learning.) Life is about doing this over and over, until you die, sometimes with small things and sometimes with the larger.
Neatness is generally about control, but with patients it’s more about the outside control than the inside. The first part of control is figuring out what you want, but the key, and more important part, is figuring out how to get it. In nursing, you want to get things into and then get things out of– and control is in the access. Access is in knowing where everything is and where everything is going. With this knowledge, and a few buckets to catch what's left over, you have control.
An Anesthesiologist taught me about neatness by not having any. Dr. P was and old-time doctor in the worst sense of the word. Looking like a melted Ronald Reagan, with thick hair dyed brown, he grandfather claused his way through medicine without any aptitude or skills, and relied on the kindness of others to not kill his patients. Most of the time, the others in his group assigned him to simple cases, but when he was on call, he covered everything.
I received a patient from him after an open-heart case and learned some hard lessons about both neatness and faith.
After open-heart surgery a patient comes back to the unit for post-op care ice cold, obtunded and with every line possible or desired poking out of every hole in them, man-made or otherwise. From the IV’s hang drugs – none on controllers, because that would be too hard to transport, and many of them duplicates of each other in all but name --and many potent in their actions. The patients come with breathing machines, bulking dressings, chest tubes connected to boxes that are supposed to suck on them, pacer wires, intended to be connected to the heart, but only taped to the chest when you get them, and a tube through a nose that’s supposed to be in their stomachs.
All of these things need to be checked and connected to gas, suction, pacers and controllers. And all of this needed to be done quickly, while the half dead and frozen patient is being manhandled without monitoring into the bed you had assigned him.
Most of the Anesthesiologists take a level of pride in how they hand over critical patients to you – most label the lines -- and some will hand them to you individually, while telling you tales of how things went, the complications, and what to expect. The transfer from the OR to the unit is dangerous and stressful at best, but with a good doctor, and some basic help – it’s manageable. It’s why we get so much training, and why we make the big bucks.
Dr. P brought back his patient from the OR with all of the lines crammed into two separate paper grocery bags – one for the left and one for the right. They were secured by large red rubber bands and tape. Alone with me in the room, he left immediately after helping me slide the patient over to the bed, saying, evidentially to me, “Here you go girls,” as he walked away. I was the only one left in the room as he walked away.
I was left standing alone in a room with a critical patient and had no idea of where to start. I was paralyzed with inaction, the task before me seemed overwhelming and impossible. As I stood there, I really thought the patient was a dead man, and my mind whirled with thoughts of excuses and things to blame. But what I did was different than my thoughts.
I connected his breathing tube and started the ventilator. I unwrapped the bag and found the arterial line, and connected it to the monitor. I put chest leads back on him and connected them. I found one IV that looked good and set it up on the controller. I found the drips of medicine and connected one of each type into the main line IV I’d chosen.
I did stuff, trusting that my training would lead me to the next right thing, but also trusting that it would all work out until I got there. At some point in the doing of things, I looked around and up, and saw that the room looked more organized, that I had a handle on what was going where, and also what should go where next. Eventually I had things arranged exactly the way I wanted them, and was in control again, for the first time.
Neatness and faith – two lessons I learned that night from an idiot.