Death is swallowed up in victory

“O death, where is your victory? O death, where is your sting? The sting of death is sin, and the power of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ. Therefore, my beloved brothers, be steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain." 1 Cor 15:55-58

nights:

meth addict threw a table at a fellow nurse- I get to bring in the ativan

it's okay that you pulled that tube out (2 nights in a row), I know it must have been disorienting waking up in the night, thinking you were at home

seeing as you just had abd surgery, it is not advisable to return to construction work so soon walking on rebar, even though wearing kevlar

sir I know you're an electrician, but since your doctors want you on bedrest, it might not be an opportune time to revamp the motor on the hospital bed

You were so violently ill, I spent most of the day expunging bodily fluids, the clean sheets a tent over your thin frame

today you are finally cleared to leave the hospital
we exchange a polite handshake
and you thank me for being with you during your worst days
but as I watch you striding away down the hall,
I feel so much relief and happiness
it is I who should thank you.

warm blanket
risks
everything is blue
don't remember anything
marking pen - x on limb, forehead, shoulder, leg
blood transfusion consent
belongings in a bag
blue hair nets

what are the last words I can say to you
when you disappear behind the OR doors,
will I see you again

I'll see you when you wake up
we'll take good care of you
the surgeon is excellent
you're in the best place to be for this procedure
you'll be fine
everything is going to be okay

longest night

waiting for his wife to come out of surgery
he collapses
he is found on the bathroom floor in asystole
there is an immediate attempt to resuscitate him
but it is too late
the "code blue" sounds flat, as if the announcer knows that there is no hope

the doctor asks for a "death pack"
only a folded shroud and a few papers
but it feels so heavy in my hand

how to be a secretary on an oncology unit

when a family member asks for a toothbrush,
he/she really needs two

offer water/juice to visitors sitting, unmoving
waiting for a loved one to come out of surgery
they have forgotten thirst
the hands of the clock are fixed

show kindness to those who are demanding
they have been too anxious to eat or sleep much
trying to hold everything together on the surface, when inside breaking
tucking anxiety away behind tired eyes, clipped voice

"sleep chair" is a misnomer

be efficient, follow through-
it seems like everything is taking too long because you have been waiting for labs, for authorization, for doctors, for medications, for test results, waiting for the pain and nausea to subside, waiting for this to all be over

I know that you need me to repeat things, because the diagnosis is still so new, numbing
you retreat, a protective measure, and I call you back

goal of all this- to get you home, the haven that a hospital could never be

Distance

You're so much the expert
I so much the novice
truthfully we are too far apart on the professional practice continuum
to ever meet

though we may walk the hospital corridor in a seemingly linear path,
appear at the bedside in the same physical time/space,
the circuitry within our minds function in entirely different dimensions-
intersecting briefly- and then only because you are overgenerous and double back for me

1 week in hospital

Waiting for him to come home
Call from ER- he's been brought in by ambulance, having fainted
CT head, ECG, x-ray
pale
6 hours of blood transfusions

no sleep in the hospital chair
5am blood test
7am endoscopy
7:20am There are ulcers but it looks like stomach cancer
recovery room

waiting
biopsy results, tumor markers
CT abdomen- enlarged nodes

nurses
transport
lab techs
Primary care doctor - "doesn't look good"
GI specialist
attending - "let's not jump to conclusions- let's just call it a mass"
intern
surgeon
pathologist
cardiologist - "slight risk of heart attack on table"
oncologist - "This may or may not require chemotherapy"
radiation oncologist - "There are several treatment options,
nutritionist

there are no more tears
eyelids are stiff

CT chest
not enough tissue- another endoscopy

"I don't want to be cut open"
"I don't want to die"

Psalm 23

¹ The LORD is my shepherd, I shall not be in want.

His chest heaves with the effort of sitting up
"I'm so weak- this is my last day here, I don't want to fall"
"I won't let you fall."

² He makes me lie down in green pastures, he leads me beside quiet waters,

his sister brought a picnic basket of his favorite foods,
I carefully label and store each item in the fridge- pretending not to notice that they are unopened and untouched,

³ he restores my soul. He guides me in paths of righteousness for his name's sake.

⁴ Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.

His voice, gasping and ragged in the intercom- "I can't breathe"
reflexively
pulling the nurse with me- get oxygen, find RT?
jogging to the room at the end of the corridor

⁵ You prepare a table before me in the presence of my enemies. You anoint my head with oil; my cup overflows.

The nurse stops me, "What are you doing? You can't do anything for him."
in the pause I remember that I am employed as a secretary. And that he is DNR.

⁶ Surely goodness and love will follow me all the days of my life, and I will dwell in the house of the LORD forever.

I reschedule a final treatment twice as the family conference runs long,
beg the kitchen to send up ice cream at their inconvenience, because he wants to have the cool, sweet taste of it,
pray for his boys

asleep

if I lay down
my back will curve into the floor
limbs will move freely
wings and fins

Third Interview

I'm used to being invisible
I like my drab coloring and plain face
no pretense

bit short on cash for tuition- interviewed for a waitress job
a surprisingly short interview:
"I need you to be warm, attractive"
"Let me see you walk over there and back"

First night:
- purchased some eyeliner
- showed up in black slacks, was told to change
- one of the other girls took me aside, "make sure you tie it securely"

I pause in the doorway for a moment- sheathed in blue silk, hem embroidered with golden thread- no longer invisible, but afraid
"If you don't get out there, I'm going to FIRE you RIGHT NOW!!"

stepping into a crowded, dimly lit room, struggling to balance a tray of wine glasses
"How is it that you serve red wine in a chilled glass?"
(trembling slightly) "I'm so sorry sir, it's my first day- please, let me get you another"
(It seems I've led a very sheltered life, never before having received such a look of disgust)

the downcast eyes, the painted smile - as a child I had learned these as signs of respect
but I am no longer a child
I say, "More tea?"
He hears: See how soft my flesh is, I don't speak enough English to make any trouble
(I want to let the teapot slip, let the boiling water scald him. I cannot. And he could probably break my wrist with one hand)

I quit. I think the others were glad to see me go- I did not bring in as generous tips.




"What good will it be for a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul?" - Matthew 16:26

"Watch and pray so that you will not fall into temptation. The spirit is willing, but the body is weak." - Matthew 26:41

Fight to Live

“The whole world consists of two classes, different in many things, but alike in this: That both are obliged to labor all their days. They are those who serve sin, and those who fight against it. Both experience pain and weariness. Sin is a hard master and a formidable foe. If you do its bidding you are a miserable drudge. If you war against it you will receive many wounds in the conflict. It’s hard to tell who is more wearied,the carnal who obeys the flesh or the spiritual who crucifies it. Both are compelled to labor, both are weary. The one is weary by sinning, the other wearied of sin. One of these strifes will soon be over, the other will never cease. If sin be your antagonist there will soon be peace for if sin cannot be taken wholly away from you, you will erelong be taken away from sin. But if sin be and till death abide your master, there is no deliverance from that yoke.”

— William Arnot (1808-1875) | Minister, Free Church of Scotland

Second Interview

I'm more selfish than I thought. I will do many things, but the idea of being required to work with hazardous chemicals terrifies me. Despite national recommendations, pregnant staff give chemo, there is chemo residue on bed linens, can be absorbed through the skin. These drugs are so toxic- they have to be, enough to kill liquid cancers and wipe out bone marrow in preparation for a stem cell transplant. Untreated, the diagnosis is fatal, but the treatment is so intense, it has the potential to be fatal also.

“Detection of drug residue in urine can take from 12 hours to 7 days.The ONS recommends using a disposable gown and double gloves for 48 hours after administration, and NIOSH extends those recommendations to 7 days for specific drugs. Linens should be handled in the same fashion. This is particularly important information for ancillary staff that may not normally receive drug-specific training or understand the potential dangers of these drugs."

"In terms of risk potential, a recent survey of more than 3000 oncology nurses showed that those who administer chemotherapy before and during pregnancy were 2.3 to 5 times more likely to give birth prematurely and have children with learning disabilities, especially language and motor problems. For this reason, both the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice and the ASHP Guidelines on Handling Hazardous Drugs state that employers should allow employees who are pregnant, breast-feeding, or planning to become pregnant to be given non–chemotherapy-related duties during this time frame"


Eisenberg, S. (2009). Safe Handling and Administration of Antineoplastic Chemotherapy. Journal of Infusion Nursing, 32(1), 23-32.

National Institute for Occupational Safety and Health. Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in the Health Care Setting. Washington, DC: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2004. NIOSH Publication No. 2004–165.

Polovich M, White JM, Kelleher LO, eds. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2005.

first interview

do I have the fortitude to do this
it's a tough job
most people wouldn't want it
but these burn victims need care as much as the next patient
or more
it's such a long road to recovery from such horrific wounds
can I take care of a charred body in an induced coma on a ventilator
do all I can to protect that body,
so that if/when the patient wakes from the coma,
he/she will have something functional to return to?


Isaiah 41:10
Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

Send help

from medical volunteers, Haiti:

Leogone, city of tents
soccer amid rubble
kites, helicopters
generators run as long as there is diesel
surgeries in courtyards
33 weekers born on a tap tap taxi- a neurosurgeon does the c-section
Filariasis, typhoid, malaria, acromeg, ostegenesis imperfecta, conversion disorder
st. rosa lima orphanage is gone
180 morts
bag vent ketamine/propofol
amputate
maggots dug out

"I know this place like my pocket"
text messaging to direct food/aid (4636)
haitian, creole expats translate "here is anywhere"
chat, click, get coordinates, there are no street names

union haiti students, marine corp remaps, skilled jobs for refugees

"the quake did not kill my family it was the system, lack of infrastructure"

dialogue
architects at UCB need to talk to docs

Fond Parisien, field hospital
tents from S. Korea
volunteers from everywhere
DMAT TN
Japanese red cross
teams from Brazil, Ecuador

lost kids- red band, unicef, orphanage placement
airlifted to dominican republic, any field hospital
blind ex fix

without

for a terrifying minute
there is silence
everything is in darkness
inner workings of the hospital halt
lines are down

is it seconds, minutes?
before the hum of the generator picks up, electricity coursing back through wires, inflating lungs, reading hearts, steadying pressures, labs

not only the patients on this floor
every room, every floor
machines malfunctioning
the patient lying on the operating table
family trying to reach their loved one on the 15th floor when the elevators are down

then the threat of fire- how to transport patients, it is an impossible choice
then a code- soul forced back into the chest, maintaining breath and beat

relentless pace
code cart flying down the hallway
sprinting to get to the room
every effort is given
because there is nothing more important than this



Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. (John 14:27)

a day, a month

such a kind smile you offered everyone
even though your feet tingled painfully
and radiation was to you both cure and carcinogen
you took laps around the hospital corridors
en route to that much needed transplant

a few weeks later I can't recognize you,
your limp form in the bed
trembling in fever, only a few platelets left
marrow filled with young useless blasts, crowding out the rest
hardly breathing now

How will you get to that shining city of hope?

God will take you there
see even now angels are alongside you

3 wishes

luggage lined up along the wall
they will stay another week
in this private room with 1 window

she cheers the nurse:
that "stupid thing" came back again
but they got all of it out this time
you go ahead to lunch, don't worry about a thing- I'll be here with him
he pretends he is not in pain or nauseated
though the tension in his body betrays him


please dear God let them
walk out of here and fly home

__________________________________


the bloody vessels that lace the arm,
a river delta nourishing rich soil

in a drought
not a rivulet of blood flows

in famine
this wasteland
blackened and parched earth,
withered and crumbling flesh
weighted down, cold, numb

it is better this way
she will not feel the blade

_______________________________

there are some languages universal
i.e. pain

there are some entities universally frustrating
such as insurance companies who will not cover the supplies for wound care

Strips of guaze like the long glistening bodies of tapeworms are drawn from the wound, cut so deeply it is a cavern of flesh

If the excised chunk of bleeding flesh riddled with tumors could be sent in as an appeal
perhaps then the claim would not be so readily denied



"When you pass through the waters, I will be with you; And through the rivers, they will not overflow you. When you walk through the fire, you will not be scorched, Nor will the flame burn you." --Isaiah 43:2

I know this isn't the Crimea
one can't survive on a volunteer's wage
but in this place and time
how can monetary compensation
motivate people to "care" more about a patient?



everything is quantified
price of life/death
price of vori/fluc

vent

A dragon alights beside her
churning the air
Its translucent neck contorts
plunging between twin cords
Its breath filling the narrow passageways

She lives

Studying for the board exam

- First a litany of symptoms:
describing the countless ways in which people may come to experience pain and suffering

- Then a listing of treatments/procedures:
complications of which may lead to additional hardship

- And finally a collection of medications:
although with unpleasant side effects, these may be able to alleviate symptoms, and provide long term benefits- if only these were affordable

(repeat until thoroughly disillusioned)