i went to a code and i did not panic.
this was a big thing to me.
i have become so superstitious that i hesitate to even recall the auditory memory of the calm lady's voice from the overhead speakers, "attention, attention attention. code blue, 2-i.c.u. attention, attention attention. code blue, 2-i.c.u." when i am at work, i keep the sound out of my imagination for fear of summoning it up in real time. but that's what happened, i heard it with my ears and i got up from my seat and i headed for the stairs.
i practiced breathing.
in the room a naked woman, my age, was thrashing around on her bed with a big mask on her face, struggling to breathe. the bed was surrounded by people in scrubs, and i pushed my way to the side of the bed and started listening to her chest, bobbing and weaving to stay with her. a young nurse, with a giant full-color tattoo of a staff of aesculapius made into a crucifix on his arm, wiggled in next to me and started reciting.
alice is a 46-year-old female admitted today for intractable rectal bleeding who just received her second unit of packed red blood cells per dr martin's orders when she suddenly stated she was short of breath and brady'd down [dropped her heart rate] to 30. we gave her a milligram of atropine and started chest compressions and she came right back and became tachycardic in respiratory failure like you see right now.
her chest sounded like someone crushing and uncrushing a big paper bag - loudly.
do you want i.v. lasix?
just then a tiny hospitalist raced into the room yelling, start lasix now! alice, can you hear me? alice, can you hear me? it was her patient.
so i scooted back out of the crowd and checked my pulse.
just then i realized that one of the reasons i even felt okay going inot medicine in the first place is that i have always been "good in a crisis," never panicking until it was all over, if at all. what happened? now i am counting as a big victory the fact that i was able to stand there without becoming faint.
and still, still, still, it's the phenomenon it's just not okay to talk about.
the next morning i went to see how alice was doing, down in 2-i.c.u. "she's posturing," the nurse said tiredly, passing by on his way home. she just kept pouring out blood all night and they kept pouring it back in. liver failure from the booze and hepatitis c from i.v. drug use made it so all the big vessels leading to her shrivelled, woody old liver just swelled up and burst. she was experiencing a "critical care clotting catastrophe," and brain damage now was making some of her muscles strain while others went limp - posturing... her long-lost sister was going to try to come in before work, or rather, the sister to whom alice was long-lost... decisions were going to have to be made by this sister... for example, alice remained full-code so that as she crashed over and over again, "everything will be done"... same old, same old, i'm afraid.
alice could not have done all that drinking and drugging all by herself - where were her running mates? maybe they should stagger in and decide what to do with what was left of her.
and maybe this is why in sudden urgency, can't kope - i can't keep my mind on doses of bicarb and tidal volumes and shockable rhythms - they seem crazy inadequate - i get all smeared off into the Land of Seemly. dammit, jim, i'm a social worker, not a doctor! but that's not really true - i'm a midwife, not an auto mechanic. it's also not true that i "can't keep my mind on." the problem feels like a problem of all those freaking-out nurses and rapid-responders staring at me going what do you want? what do you want? with naked dislike in their eyes - likely they all dislike the code as much as i do - as well as dislike white coated doctors and snotnosed residents in particular and likely the Old One most of all - especially if... well anyway.
it's okay to go on and on about this like this, because this is my journal.
i'm just saying.
part 2.
i have been sick for a month and a half - that's what rufus does, makes it impossible to recover - and only starting just now to see daylight at the end of the incredibly long and difficult tunnel, after two courses of antibiotics and a week of high-dose steroids. so many things i have wanted to write about, but unable to even get my own damn glass of water.
last night i caught another baby. i can't even go into the details. suffice it to say that there's little worse than a nurse who hates her job and is angry about it, especially in a room with an anxious first-time mother hoping to give birth naturally one moment and crying for general anesthesia the next, along with little old me, so tired, so tired, and therefore so disheartened whenever the angry nurse rolls her eyes and sighs as i go about my back-rubbing, deep-breathing way of fending off the epidural.
that afternoon The Funny One, our attending, had been giving a lecture about how "there's no such thing as a low-risk obstetric patient," provoking me to loudly say from the back of the class, "or at least that's our ideology," and then duck my head down, but he knows very well who i am; as The Funny One, part of his office is to provide the jokes and gag gifts for the graduation roast the residents "get to" participate in, and he already made it plain that my personal vocabulary term "vaginal ecology" would be a part of my display...
so anyway, due to his offhanded and totally confident assertion that "it's the ones you think are low risk that go to crap on you," i found myself again and again, over six hours, nervously starting at the computer monitor of the fetal heart strip and obssessing about every single contraction, and had to go take a walk when i realized how utterly stupid and, well, actually, harmful it was. my anxiety was not helped a bit by the cynical and - and i never say this about another worker - lazy obstetrics resident, who sits on her lazy ass drawling, "her heart tones have been crappy all day, and i should know, since i'm the one who had to watch 'em all day - " (which was her job, while i was in clinic all day). i mean - not that i needed her help - it was just - like wading through molasses - to get through all the bad vibes and gloomy predictions - to stand between them and my girl in labor who was just struggling to get through it, sixty seconds at a time.
did the birth turn out fine? no thanks to the rest of the staff, it did. interestingly, nervous norvis, our attending, was there to lend a hand; i was able to ignore his nervous mutterings about what could happen any minute "to the heart tones." he very generously assured my girl, repeatedly, what good hands she was in - with me. "you've got the best labor coach we have," he told her.
so now mom and baby are nursing happily, and it turns out i guessed right for the first time - eight pounds. i had actually, literally, taken 4 liter bags of normal saline and heaped them up on a counter at the clinic and put a towel over them and felt them up all over to see if it felt like how big her belly was. it wasn't quite that big. so i guessed three-and-a-half liters, or about 8 pounds, and was right.
later, my patient told me the nurse had told her twice, "we'll just see how far you get before you ask for the epidural." she also told me, "it hurt so much! it was horrible! i can't believe i did it! i stuck to my birth plan! i did it!" i wish i could show you a picture of how beautiful this six-foot-tall, 23-year-old coffee-colored goddess is, with long angel wings tattooed down her back, her eight! pound! daughter in her arms.
part 3.
it's not all misery. the other day i was very happy because i felt like i did a good job in clinic.
a sixteen-year-old girl came out to me. she didn't need a prescription for birth control, because "i'm just talking to girls right now." she wants to be a poet. she entered one contest and won the editor's choice award. so i told her about my mother who became a poet and about the importance of getting your stuff out there. i also got her vaccinated against cervical cancer. i also told her about her civil rights as a teenager, and the privacy of her health information.
then i went to talk to her thirteen-year-old brother. he's been having a hard time with his parents because they don't want him to watch video games anymore - "they say i'm too old for that, and i should have outgrown it by now." so i told him about my son who has a new job as a video game developer. the boy's eyes got as big as saucers. he wanted to know all about how my son applied and what the interiew process was and what kind of qualifications a person might need. i told him how to make a privilege contract with his parents. i also told him about his civil rights as a teenager, and the privacy of his health information.
then i talked to the mom, who's just real tired with her new 6-month-old - the baby that came along as soon as she sold the crib.
then i talked to the sickle cell kid who just turned 18 on valentine's day. he's taking a lot of narcotics and being really squirrelly about it, too - getting himself in trouble, like a kid. i talked to him for half an hour. at the end, he had an enthusiastic plan in hand to get his g.e.d, take the driver's licence test, and register to vote. i thought it might be good for him to get his mind off his chronic pain for a little while.
once in a while you get a glimpse of what i normal life could be like.
i'm just saying.
part 4.
up in 6-i.c.u. i was taking are of a little old lady who was having a very hard time breathing until an interventional radiologist stuck needles in her chest and sucked out a couple of liters of fluid. after that, she was ready to go home, and i couldn't convince her to have anything else done at all. her right breast is twice the size of the left, woody hard, with a soft oozing center where the nipple used to be. no bad smell; nontender to palpation; she was fine with it; she was really quite sweetly at peace with the whole situation.
she explained the situation to me:
"i was in church and i laid my hand on my breast, and the lord spoke to me and said, you have cancer.
"this holy oil is all the pain medicine i need. i don't want no more blood tests, i don't want no more oxygen, i don't want no more medicine. don't get me wrong, i know you doctors have to do your doctor business, but i don't need no doctor. my faith is in the lord and he will heal me if it's his will.
"this bible right here is all i need. see this, psalm 116, this here's all the medicine i need. read this. go ahead, you read this to me."
i said, sorry, i have a meeting right now - maybe later - got to go - can i get you anything before i go? okay, then, i'll see you this afternoon... but later i felt bad and i went back where the book was lying open to the same page in her lap, as it was all day and all night, and i went ahead and read it out loud at her bedside.
The sorrows of death compassed me,
and the pains of hell gat hold upon me:
I found trouble and sorrow.
Then called I upon the name of the Lord;
O Lord, I beseech thee, deliver my soul.
The Lord preserveth the simple:
I was brought low, and he helped me.
Return unto thy rest, O my soul; for the Lord
hath dealt bountifully with thee.
For thou hast delivered my soul from death,
mine eyes from tears, and my feet from falling.
I will walk before the Lord in the land of the living.
I believed, therefore have I spoken:
I was greatly afflicted:
I said in my haste, All men are liars.
What shall I render unto the Lord
for all his benefits toward me?
I will take the cup of salvation,
and call upon the name of the Lord.
I will pay my vows unto the Lord
now in the presence of all his people.
Precious in the sight of the Lord
is the death of his saints.
later, after she'd gone home, one of the other residents told me how he'd rounded on her late at night, "and she got me to read this bible chapter out loud to her - " and the intern, overhearing, said, "you guys are suckers. i just said no."
she also showed me a booklet of pictures of her house. the last photo in the booklet was from the seventies. she was on a plaid couch wearing a purple velour jumpsuit and a big gold cross, with a big jheri-curl afro, her arm around the shoulders of a skinny white guy with one of those little christopher-street moustaches. "who's this guy?" i asked. "oh, he died," she said, clucking her tongue and shaking her head.
precious in the sight of the lord is the death of his saints.
part 5.
my final story is just a little transcript. i was working in the pediatric emergency department in the middle of the night, and one of the nurses asked if i could take a little time to sit with a mother who was very upset. "she's crying so hard, i can't understand what she's saying." her eleven-year-old son - the patient - was in the next exam room, stable, waiting to be seen by social workers and cops.
the mother, like the lady said, was sobbing and sobbing, having a hard time talking. she was hunched over a bible she held closed on her lap, wiping her face with her fingers. it seemed that her husband of five years - he just never did like her son. she said, "all along it was just the verbal abuse, telling him he was stupid, calling him a liar all the time, calling him names - i knew it was wrong, but i thought i could h-h-help him to ch-ch-change." this time he had seized the kid by the chest and thrown him up against the wall, then dragged him sideways like that down the hall, then let go of him, cold-cocked him, thrown him onto the bed, picked him up again, threw him at the window, and so on... as medical staff i was responsible for getting the details of exactly how he landed each time - hit his head? lose consciousness? hit his back? twist his arm? - details that are inextricable from the story of how her son is a good boy who wants to be a minister of the lutheran church when he grows up and attends a youth entrepreneur club where he sells bible-story board games he invented himself, from which he was home late, causing his stepdad to go insane, his mother running down the hall after them, crying and screaming to please please stop.
she said she'd call the cops, causing the stepdad to start crying, begging her not to, then scoop up the four-year-old sister and head on out on his motorcycle. yes, i said motorcycle. yes, it's february, with ice-covered roadways.
oh, she cried and cried and cried and cried and cried as she told the story. it turned out that when the boy had recovered, he said, "we've got to get out of here," and talked her out to the car to drive to the store and get boxes. then as fast as they could the two of them started packing boxes. they spent about 4 hours doing this, until about ten pm, then packed the car and drove over to grandpa's (maternal grandfather's) house. turns out stepdad had dropped four-year-old sister off there previously, and gone off again on his motorcycle - so they were all pretty much safe and sound, until about two a.m. when the boy suddenly woke up crying and begging to go to the hospital.
by this time mom was able to take some big shuddering breaths. she was pretty much cried out. so i went in to talk to the boy.
he was a skinny kid, a typical little pitcher with big ears, lying very solemnly in the hospital bed. the lights were out and the curtains pulled, so there was just a little glow of light from the quiet, dead-of-night, emergency-room hallway. his mom and i pulled up chairs to the bedside. his mom hunched over her bible again, and as my conversation with him went along, she started murmuring, "yes, lord," "amen, and "do, lord," to what her son was saying.
and what he said was so surprising, to me, that when i was done writing orders i grabbed a progress note and wrote it all down verbatim.
my chest hurts here, where he grabbed me. see this? when i cough, it hurts. at first i thought i couldn't breathe and i was scared. i thought maybe i was having a heart attack, and that's why i wanted to come here. but now it just hurts. if i press on it, it hurts. i didn't hit my head. my arm's okay.
when i woke up, i was having some kind of a dream where i was walled in by boxes, and that's what was making my chest hurt. i guess we packed too many boxes today. i don't know if the boxes were going to fall over on me, in my dream - they were like walls moving in on me.
but you know - i've been thinking a lot about this while i've been lying here, and i don't feel bad that this happened.
i don't feel bad that this happened. the way i see it, everything happens for a reason. god lets things happen to you for a reason. if this didn't happen to me, i would have never know what would happen. i would have gone on being afraid of what would happen. it's like a sneak preview of the test. now when i come to the test, i'll know i can pass it. i know i can handle it.
it's like you have a destiny. everybody has a destiny. you have to meet your destiny, and accept it. god shows you what your destiny is, and then you know that's your destiny.
my mom says she blames herself for what happened, but i tell her it's not her fault, it's not anybody's fault. i know my mom wants to do what's best for me and my sister. i know my mom loves me. i would never blame her or even blame anybody for what happened. and i don't blame myself, either. we're all in god's hands. god shows us his plan for us.
don't get me wrong. i think my dad should be charged with something, because he did wrong. but i believe it's god that let these things happen, and god makes everything happen for a reason. i can't let what happened hinder me from my purpose. it says, "you will not be turned aside."
then it was time for the cops to talk to them.
The Staff of Aesculapius is the healer quest artifact.
It is neutral for wishing purposes. Its base item type is a quarterstaff.
It deals double damage to all monsters and also gives hungerless regeneration.
If invoked, it heals half the points you would need to return to full health, and cures sickness, blindness, and sliming.
It does not cure blindness caused by a cream pie.
--from Wikihack
so that was my month.
