a bad case of the monday's.

for most people, you might say that they "get monday"--you know, in other words, it is the person who doesn't like monday & goes about his or her day with a bad case of the monday's. BUT, apparently i'm special...because mondays "get me". i swear it--they are out against me.

remember two weeks ago? that monday turned out fine after an incredibly frustrating start. and then there was last week, which in the book of my history tops all other monday's ever lived by me...

as all monday's do, it started out innocently enough. i had decided the night before that my pants were getting a bit too tight this early on in the holiday season, which warrented a good workout the following morning. and since i had to report for my first day in the ER @ 7am, it made for a very early morning. with my lunch box, purse, book bag, & gym bag in hand i made my way down the slightly-snowy steps @ 5:40 am. i brushed the snow off my car window (with my bare hand because i'd forgotten gloves) and was headed to the gym in a relatively short period of time after i threw my pluthera of bags in the backseat.

once i walked through the fitness center doors, i ran to the locker room to deposit my bag in the toilet, set up my station for Body Pump in the fitness room...and waited. And i waited....and waited...and waited....and 3 other people walked into class and then we waited....and waited...and waited. we all waited until someone from the front desk called and said that the teacher forgot he had to teach that morning & wouldn't be joining us. WHAT?!??! you mean i got my butt out of my freezing cold apartment at freaking 5:40 this morning to sit on my butt in the freezing cold gym waiting for the teacher to show up??!!!?!?!?!?!?!

after a quick workout upstairs i figured i would just show up early for my ER shift so i might leave a little earlier that evening...which is when i walked out to my car & realized that my soy milk that was so lovingly self-packed in my lunch box had tipped over when i'd thrown my bags haphazardly in the backseat. And that lovingly self-packed soy milk now decorated the floor, seat, white coat, and purse of one very frustrated girl. i squatted in the semi-dark parking lot wiping out the lunch box, wiping off the seat, and sorting through the baggies of soggy food that was supposed to have been my lunch. oh, and did i mention the fact that i was almost run over by a crazy west virginian trying to find a parking spot?

i showed up in the ER with a large yellow stain down the front of my coat--caused by drying soy milk but slightly resembling wiped-off bird poop. fast forward a few hours & the ER was bustling. people were filling the rooms with ridiculous complaints...but the most exciting part was that there were a few legitimately sick patients.

one woman had a chest tube put in after developing subcutaneous emphysema--and subsequently the voice of a smurf. it really wasn't funny, but as i stood in the corner listening to someone who sounded like they'd sucked helium, i couldn't help but chuckle at the irony of the actaully grave-situation. humor gets you through everything, right?

an overdose was wheeled through the door. and after his respirations started to drop, they decided that they had to intubate. they'd given him charcoal to drink while he was still conscious (it helps absorb drugs/substances in the stomach so it doesn't get into systemic circulation) but the drugs took affect too quickly for the charcoal to work.

the P.A. handed me the suction & i immediately took a white-knuckled grip on the handle--probably from subconscious excitement at what was about to happen. and what did happen next got a little...ummm...messy. as the P.A. tried to guide the tube down her throat & into her lungs, we all realized that she wasn't sedated enough for her gag reflex to be gone--and so he was struggling with the positioning of the tube (there are certain landmarks you have to look for). as we rejoiced that he'd finally gotten it in, a huge spray of black charcoal poured out of the tube & shot at least 2 feet in the air...covering the nurse who was holding the man down, covering the P.A.'s lab coat, and soaking my pant leg. the humor of the situation peaked when i continued to stand there with a white-knuckled grip on the suction, completely oblivious to the shrieks & pokes of the nurses to put the suction on the shooting charcoal-mixed-with-stomach-acid fluid that was coming from the tubed man on the table. and perhaps even more hilarious is that it wasn't until at least 25 seconds later (which, of course, seemed like 10 minutes) when the P.A. physically yanked the suction out of my hand that I finally surveyed the black-stained nurses now soaked with charcoal colored liquid and realized what had happened.

when we all recovered--& dried off--i realized that the lunch i had eaten was not agreeing with my stomach (perhaps it was the charcoal stained pant-leg that upset my stomach so??) and so, aware that there was a gas bubble slowly making its way down to you-know-where, i positioned myself in the corner of the nurses station that is empty most hours of the day. i stood there, probably looking quite the opposite of inconspicuous, and let that gas bubble go--and the sound that came out was, quite possibly, one of the loudest i've ever signed off on. which is when i turned the corner & realized that a case worker was sitting at the desk on the other side of the wall i just farted against.

after 8-or-so more patients it was almost time to leave, & i gathered that i'd better stop in the bathroom before my bladder exploded. i walked in, turned the light on, & paused in the mirror. before me stood a frazzled, thoroughly exhausted girl....and one pant zipper that was gaping WIDE open for the world to see.

the world which included the last who-knows-how-many patients....

"...and for everything else..."

1 pack of cigarettes: $4.75

cost per week of smoking 4 packs per day: $133

money spent in 1 year on smoking: $6916

cost of smoking over 25 years of smoking 4 packs per day: $172,900

sum of annual bills for once-yearly doctor's visits in 25 years of smoking: $7500

x-rays at age 63 because of shortness of breath: $450

cost per month of Spiriva inhaler to help with shortness of breath: $85

repeat x-rays at age 63 years 8 months because of shortness of breath & pneumonia: $450

Nebulizer + Albuterol for continuous trouble breathing: $200

oxygen tank & tubing: $250 per month

cost of ambulance trip to the hospital because of trouble breathing & nasty cough: $2500

eight hour ER visit for worsened shortness of breath: $800

total cost of cigarette smoking in a 63 year old: $187,885

a real-life lesson about the consequences of smoking for the 18 year old on the other side of the curtain: PRICELESS

She came in for a toothache…because she “just couldn’t stand the pain.” The light that came from my penlight reflected against black teeth & weeks (maybe months) of plaque buildup. So she sat on a bed in room #1, because she didn’t brush her teeth.

He came in with a scratch on his face—mom said his dog did it. And under his eye was a ½ inch scab, not bleeding. He played & laughed when I asked him if he was in pain. His parents seemed more concerned about the tiny scar that would sit on his face that they did about the possibility of him losing his eye to infection. So he sat on a bed in room #2 because he was playing with his dog.

He told me he had a stuffy nose, and then got nervous & wanted medication when he discovered his stay would be more than three hours. We had to finish his lab tests (legal precautions, we said). So he sat on a bed in room #3 because his nose was runny.

Her throat hurt “so bad that [she] couldn’t swallow”. She told me she thought she’d just “pop in” to the ER to “get some medicine” because her doctor’s office was busy. It had only been hurting for a few hours. And so she sat on a chair in the corner of room #3 for five hours because it was “convenient.”

She didn’t have a fever, no infection, no change in attitude or appetite…just a runny nose. Her parents called the ambulance—maybe because they were scared at the clear fluid coming out of her 3-week-old-nose. And those paramedics drove through two inches of snow to pick up that 3-week-old baby…who sat in room #5 with a simple runny nose with two overly-naïve parents.

She had diarrhea in room #6.
He had a belly ache in room #7.
A sore leg occupied the bed in room #8.
Her constipation bottom dirtied the sheets in room #9.
A fussy baby in room #10.

Her blood pressure was dropping. Oxygen saturation was too low. Heart rate was sky high. She’d eaten dinner…then slumped over in her chair. They wheeled her in on a yellow stretcher. She came in because she was DYING….and her stretcher paused in the hallway because all the beds were taken.

conversation.

from where i stood, he looked like an old man. which, in fact, he was. slumped over in his wheelchair, his bright green hat with "Lucky Dad" written across the front was a stark contrast to solemn whispers surrounding his presence at the nurses desk. they had found him in his room--his O2 sat's 86% & quickly dropping, despite increased oxygen through his nasal cannula.

Dr. W: We'd like to send you to the hospital, Mr. Smith

Mr. Smith: I ain't going. If I'm going to die, I'm gonna die right here!! [raising his shaky hand & pointing his finger downward on "here", as if enunciating his point]

Dr. W: Mr. Smith, I think you are sick & we need to get a picture of your chest.

Mr. Smith: Then you bring in the xray...we'll take the picture right here.

Dr. W: Mr. Smith, how to you think James would feel if I just let you die here? If it were James in this position, what would you want us to do for him?

Mr. Smith: Everything you can...

Dr. W: Then how do you think he feels about you?

Mr. Smith: I am 88 years old. I 'dun & lived my life. He still has to live his.

Dr. W: Mr. Smith, I am okay with you dying. But I don't want you to be miserable for a couple of days while your lungs fill up with fluid...and then die.

Mr. Smith: No, doc. I'm ready. I'm waiting. If you have to send me, take me to Dr. Taylor. He'll know what to do.

Dr. W: Well I can't make you go.

Mr. Smith: No you can't...& I'm going to die righ t here.

Dr. W: Okay we'll do what we can.

Tell me, how am I supposed to handle that conversation? How am I supposed to be an innocent bystander & maintain my composure (which I did not--I pretended an eyelash fell in my eye when the waterworks came on)? How am I supposed to be part of medicine, respect patients wishes, learn about the amazing interventions...and then let them ignore something that could save their life??!

And then again, at 88 years, how can I blame him for being ready to go?

tiny.

Why is it?

Why is it…

…That when old people die in their sleep, we take a deep breath, find a memory, say that “they had a good, long life”…and move on with our lives?

…That when old people die from a horrible disease we wish they would have died sooner, more peacefully; the justification of the disease often not even questioned.

…That when old people lose their spouses we attend the funeral, marvel at their 50 years of marriage and go about our days as if they have nothing to offer.

Why is it…

…That when young people die we are struck with grief for months, even years on end; we forget to breathe, proclaim that they didn’t live long enough for us to find a memory, and sulk in the fact that they were shortchanged on life.

…That when young people die from a horrible disease we wish they would have lived longer, disease free; the justification of the disease questioned daily because it just “isn’t fair”.

…That when young people die and leave spouses behind we attend the funeral, shed more tears than we have in the last three years combined, build a monument of sympathy for their widow and proclaim how much they would have had to offer, had they lived just a little bit longer.

Why is it that we feel the death of someone older is justified, but death of someone younger is always unfair?

Why is it that our hearts break for the young widow but barely skip a beat for the elderly widower of a Golden Marriage filled with fifty years of memories?

Why is it that people flock to the funerals of the young, clearing out schedules & missing appointments, while the memorials of the old are filled only with their remaining friends and a few acquaintances because we had a hair appointment that day at 1pm?

Why is it that regardless of the age, regardless of the life, regardless of the spouse or profession or contribution, we forget to remember that they LIVED.

And that LIVING is a feat in itself….

take a moment to read a few posts on this blog: http://marisavanderveen.wordpress.com/
(this man's wife passed away last year at age 33 from cancer, leaving him behind with three young children...this blog is about his grieving process...i was moved to tears)

Today.

There was a point, sometime in the past two years, where I seemed to have stopped living. The vibrancy that once infected my days, the joy in rain & snow & hot chocolate seemed to fade away. I might venture to say that at some point, I was depressed. And actually, depression, in some form or another, is so common in medical school that they specifically warn us about it during our orientation week. Throughout our first two years it becomes somewhat of a joke, our professors lightly referring us to the psychologist on staff should we need any “mental help”. And quite frankly, it isn’t taken seriously enough.

Those of us who struggled to get out of bed some mornings, either from real depression or the mountain of textbooks that needed to be read & material that needed to be memorized found ourselves in make-shift counseling sessions with our peers. Mine were each Thursday morning at 10am over coffee with five other women. We titled the time “study sessions”, but every week they inevitably turned into what some might consider a support group. And I have every ounce of faith that those five women saw me through what might have been real live depression.

And although I am doing much better (I still don’t want to get out of bed in the morning, but I’m thinking that now its just because I’m not a morning person), I still struggle with finding the JOY in each day that I once abundantly noticed. When I drive, the vibrant orange trees are just trees, the cute old man is just old, and the annoying pain patient is well, just annoying. It seems that somewhere in the midst of my textbooks and sky-high stress levels I’ve not only lost the ability to find joy…but also the patience to look for it.

I’m kind of understanding now what it means when people say that physicians had a class in medical school on how to be arrogant, rude, and a bit lifeless at times. I’m understanding now what it means to lose the tolerance for mediocrity—I’m expected to perform perfectly at my highest cylinder, and in turn I now unrealistically expect it from others. And I’m understanding now what it means to be so overwhelmed by the humanity that you encounter each day that you eventually lose sight of your own [humanity].

And in the midst of this struggle, I’m faced with the challenges of understanding where God fits into medicine, how medicine melds with faith, what my role is in mediating the two; answering the tough questions God’s way…questions about the sanctity of human life & at what gestational stage I personally believe human life begins, questions about the science (if any) behind homosexuality, pain, and neuromuscular disorders, questions about compassion & how much I’m supposed to shell out to my difficult (not to mention draining) patients, questions about how this insane thing called the practice of medicine is going to fit into my life as a mommy someday…

All this thinking has me distracted…so distracted, in fact, that I’ve stopped looking forward to the days’ experiences & started dreading the new ethical, moral, and heartbreaking cases I’ll have to mentally sift through before I can fall asleep at night. Something which very well may have contributed to my almost entire lack of sound sleep for the past 2+ weeks.

But like every change that needs to be made, it is easiest to start simply. I’m not entirely sure what “simple” is like these days…and I certainly feel like I have a long journey of “recovery” (can I even call it that?) ahead of me…in addition to more questions with answers that need to be sought out through prayer & experience.

"I have always, essentially, been waiting. Waiting to become something else, waiting to be that person I always thought I was on the verge of becoming, waiting for that life I thought I would have. In my head, I was always one step away.

...[But] life's made up of more than that one moment. Life is a collection of a million, billion moments, tiny little moments and choices, like a handful of luminous, glowing pearls. And strung together, built upon one another, lined up through the days and the years, they make a life, a person. It takes so much time, and so much work, and those beads and moments are so small...

This pedestrian life is the most precious thing any of us will ever experience...

You have stories worth telling, memories worth remembering, dreams worth working toward, a body worth feeding, a soul worth tending, and beyond that, the God of the universe dwells within you, the true culmination of super and natural.

You are more than dust and bones.
You are spirit and power and image of God.
And you have been given Today."

~Shauna Niequist, Cold Tangerines

And so my goal is to remember that…just that as a simple first step.

I have been given Today. For a purpose. For a reason.

And if I do not find success in anything else today, I will find success in Today and its purpose.

brave.

I realized something as I dodged the reclining chairs on wheels & haphazardly places wheel chairs that clogged the hallways this morning: you have to be brave to get old.

You have to be brave to watch your once youthful skin wrinkle & thin.
You have to be brave to watch your spouse struggle to take the steps he once ran, struggle to button the shirt he once easily pulled over his head.
You have to be brave to read your best friends’ obituaries in the Sunday paper.
You have to be brave to wake up to an empty bed, a quiet house, and a half-empty pot of cold coffee because no one was there to drink it with you.
You have to be brave to stand at the grave of your love of 50 years and face the rest of your life alone.
You have to be brave to watch the sunset and trust that it will rise again, to want it to rise again in the morning.
You have to be brave to see the world change around you, to see computers and iPhones and earbuds and portable DVD players and electric cars that run on popcorn oil; you have to be brave to face the technological giant that is beyond your understanding.
You have to be brave to face your second, maybe third war…and hear the stories about the bombs and explosions and loss of life…for the third decade of your life.
You have to be brave to love the friend across the hall, knowing that she may not be there tomorrow.
You have to be brave to not get jealous when people pass in peace around you…while you struggle in pain strapped to a wheelchair, stuck in a sanitized home. You have to be brave to not yearn for freedom…
You have to be brave to gain the humility it takes to allow a 21 year old glowing skinned female wash your privates and change your diapers.
You have to be brave to put a smile on your face when your days consist of darkened hallways and pureed foods because you can’t swallow anymore.
You have to be brave to see visitors that treat you like you are a child, forgetting that the decades of life you possess are well beyond their own childish understanding.
You have to be brave to look forward to the days and nights that will be filled with utter lonliness because all those close to you have died.
You have to be brave to look back at the memories of a vibrant life once lived, once full of love and activity.
You have to be brave to get old.

I don’t think I’m that brave.

existence.

He sat. Probably where he’d stayed for the last two hours—since the last body-turn by the nurses to prevent pressure ulcers. Blue curtains covered the window he faced. The heating unit blasted warm air toward his slightly reclined chair. Where he sat.

When I greeted him with a friendly “Good Morning, Sir”, I was quickly corrected by my preceptor that this person was, in fact, a female.

At first glance, I couldn’t tell. And actually, the second & third glances didn’t decipher much either. Her white hair had thinned in a male-balding pattern, leaving the peak of her forehead & top of her head entirely hairless. Since menopause, the estrogen in her body had slowly dwindled, causing growth of whiskers & stray hairs on her upper lip & chin. The protuberant stomach that overtook her lap masked any sign of breast tissue that was still present at age 97.

Only mumbles greeted me as a reply to my friendly “Good Morning”. My preceptor informed me that she had SDAT, or “Senile Dementia, Alzheimer’s Type” and was unable to communicate at all. In simple terms: over the years her brain had formed toxic plaques within the cerebral material that caused her to first forget her keys & doctors appointments, then her friends birthdays…eventually her friends, too. And one day she couldn’t recognize the very children she had borne. Not too long after, her own image in the mirror was that of a stranger. And now, at this advanced end-stage of the disease, she had forgotten how to talk. Literature tells us that her automatic response to lack of oxygen would go next…and some day soon she will forget how to breathe.

It’s a difficult disease to comprehend. Much of our bafflement about the disease likely stems from our cultures emphasis on “contribution”. We, as a society, value those who are able to contribute…to our society, to our educational experiences, to our health, our future, our everyday vanities, even to our conversations. And Alzheimer’s challenges us in difficult ways because the very people, often our parents, brothers, sisters, and friends, that have contributed so much to our lives suddenly stop contributing and start existing. And for our feeble brains to understand that existence is quite enough is often too difficult to wrap our neurons around…

This woman’s son visited her twice each day. I think he realized that her existence was enough, regardless of her contribution to his daily life. Remnants of his grade-school-looking handwriting plastered the walls with signs reminding nurses to “Only check pressures in right arm” and that “Family will do laundry” and to “Turn patient every two hours”, the latter of which was accompanied by a hand drawn guide on the direction of each turn at specific times of the day so as not to forget an angle that might give his dying mother a bit more relief.

The mystery of Alzheimer’s Disease has gripped the families of this nation, with over 147 patients being diagnosed each day. That is 147 people who will forget their keys and their doctor’s appointments. Who will forget their friends’ birthdays…and eventually their friends too. And who will one day wake up and find their own family complete strangers. That is 147 families who will be struck with the tragedy of loving a new, constantly changing, horribly difficult person that once loved them back….each and every day.

And this disease, this plague of forgetfulness that overtakes people’s brains is another intersection in my own life where personal experience, faith, and medicine collide in a brilliantly colorless display of questioning.

My grandpa had Alzheimer’s. Jon’s grandma had a form of it, too. And although we were more detached because of college & our move across the country, the toll it took on both our families was horrendous. If any consolation exists, it is that of innocence: most Alzheimer’s patients don’t realize that their memory is failing them. They, like this patient, have seemingly lost the ability to compute at all…giving slight relief (if any at all is possible) to grieved & exhausted care takers. And perhaps it’s the innocence of these patients that allows us to cope with the grief, fear, anger, and changes they face.

The brain is a black box—a mystery to even the most advanced scientists…and Alzheimer’s disease is no different. And while my own faith tells me to appreciate the mere existence of these patients, I can’t help but wonder whether or not God really intended us to live long enough for our own body to start producing toxic plaques that cause us to forget all the people & things He placed in our lives. And if He did intend for some people to eventually forget how to breathe, I can’t help but wonder what kind of lesson he is trying to teach those closest to them—in my opinion, there are plenty of other ways, much less tormenting & exhausting ways, to get the message across that this Earth is not our home. But then again, I am far from being in God's position of Divine Wisdom.

And so I’m left at this point again. The point where answers and questions don’t meet. The point where I’m questioning and experiencing and searching for reasons. Reasons why this woman didn’t slip into peace ten years ago when her children would be left with memories of hugs from their mother--a mother who recognized them. Reasons why this disease of old age is so prevalent—and reasons why people live lives with the end purpose of mere existence, anyways.

And still, reasons why God put this woman in my path in the first place…

Monday Morning.

It started out innocently enough…at least I thought it did. I had a new preceptor to find—presumably on the back roads of West Virginia. I planned my morning well in advance, which likely contributed to my disrupted sleep Sunday night…leaving me feeling groggy & not entirely prepared to face a new week at 6:05 on Monday morning.

Actually, my alarm went off at 5:15am. I had hopes of going to the gym…but after a night of restless tossing & turning, I decided against it when the music started blasting my ears only a few hours after I had shut off my light.

My preparations went smoothly enough, and aside from spilling soup all over the counter, watching my bottle of hair gel slide into the toilet and dropping my socks in the sink, I was ready to walk out the door in about 20 minutes. With car keys, purse, Nalgene, lunch box, gym bag, and books in hand, I reached for the door knob & realized that I had to pee one last time before my who-knows-how-long drive into the boonies.

As I stood washing my hands, basking in the glorious feeling of warm water in a freezing cold apartment, I realized that my almost-white-khaki pants were quite thin. And I thought about how cold I might be in the office. …which is when it dawned on me that my polka dotted turquoise underwear were completely visible on the rump view of my rather thin pants.

An extra few minutes to change my underwear.

And then I was off. Not entirely sure where I was headed, I drove along a two-lane road that curved & twisted around rock formations & cow pastures like switch-backs on a hiking trail. One thing was for certain: I WAS in the middle of no where.

About 15 minutes into my who-knows-how-long drive, I slowed down from 55mph to about 30 mph…you know, to enjoy the scenery....which in all honesty, was actually quite breathtaking. The river was foggy & I imagined Pocahontas canoeing down the river with her raccoon & birdy friends…oh wait, that was a Disney movie.

In truth, though, the trees were firey orange, the rolling hills were a faint blue color, and I passed red barns whose paint had chipped & roof slats had worn…I passed tilting shanty’s that, once loved, had been neglected for years. And I passed a slew of trailors & makeshift remodeling projects with little smoke trails sneaking out the chimney’s—a sure fire (haha) indication of the warmth that was burning inside (again…haha).

I noticed a field of horses on my left…and at the corner of the lot an avacado green trailer. And although I was driving, I slowed down enough to watch the horses for just a few seconds. Afterall, I was the only one on the road at o-dark-thirty in the morning.

Their coats were shiny, their manes were…flow-y…and really, they were so pretty enjoying their morning meal of West Virginia grasses with the Blue Ridge mountains as God’s painted backdrop. And just when I made a mental comment about just how awesome it must be to run free in a field like that, the brown horse took the liberty to give me a bit of a show by jumping on the black horses back and…….well, I’ll let you fill in the details. Lets just say they might have made more pretty horses yesterday!

And so the drive continued. After about 25 minutes of fields and cows and…ehheemmm…pretty horses, I found myself driving through a “town”. My directions told me I was supposed to turn….and turn I did….which is when I found myself face to face with a market on the corner, aptly named “The Corner Market”. I passed “Nance’s Diner” & “Matt’s Furniture” & “Trudy’s Flowers”, all reminders of small town America at its best.

I realized soon after my turn that my only further directions were to “drive” & look for the “Health Center on the left”. GREAT, I thought. At this point, it was well before 8 o’clock…and already I’d seen hills and trailer and cows and mating horses and turquoise underwear and in-the-middle-of-nowhere stores…

And so, since the office didn’t open until 8, I drove back & forth between two “towns”, looking for the “Health Center”. At one point I was driving alongside a little deer who had found himself a nice path along the white line alongside the two lane road.

It took me another 25 minutes, 1/4 tank of gas & 3 phone calls to the nurses at the clinic to find this infamous “Health Center”, which was actually another 5 miles down this road-to-nowhere…

When I walked in the door I was greeted with smiles and the announcement that no, in fact my preceptor was NOT in the Health Center he had given me directions to; the same Health Center I had just spent over 45 minutes driving to find….

He was at the “Senior Center” just a “few miles” down the road…

conversation.

i've spent the last two days with a PM&R (Pain Management & Rehabilitation) doctor--which has proved to be quite an experience. Yesterday I listened to people in "pain" (in quotes because i don't believe all of them to be legit) complain about how miserable their lives were (can you tell i'm short on sympathy?)...and today i spent the day in an in-patient rehab clinic working with speech, physical, & occupational therapy.

it was quite an eye opening experience, as i've never had any reason to visit any of the above fields' offices...and one patient in particular made me chuckle more than any other...

bits of her conversation with the speech therapist:

{first of all, let me set the stage for you: patients visit speech therapy for 30 minutes at least once per day. located in a small office at a corner table, the therapist takes patients through a series of exercises that, depending on the patient's ability & reason for admission involves anything from "repeat after me" phrases to complex math questions...it also needs to be said that apparently this patient was admitted & barely spoke during the first week of her stay--needless to say the times have changed in her world...}

therapist: (referring to my presence in the room) She's just observing, is that okay Mrs. Ringer*?

Mrs. Ringer: I'm observing my hind end right now...is that okay with YOU??!!?

therapist: Repeat after me..."rose...sweater...hamburger"

Mrs. Ringer: rose...sweating...booger

therapist: Okay...repeat these numbers "9...2...1...8...4...7...2"

Mrs. Ringer: OH LORD JESUS HAVE ooooooooooooo MERCY where in be-Jesus are you gettin' those numbers?

therapist: From this test, m'aam--off the paper in front of me. Can you repeat this sentence?

Mrs. Ringer: OH LORD JESUS HAVE ooooooeeeeeeeoooooo MERCY my hind end is burning like yesterday's coleslaw

therapist: oh wow. i'm sorry...m'aam can you repeat this sentence?..."I drove down Mercy Street & took a right at Stockton Avenue"

Mrs. Ringer: Gah!!! Well be-Jesus...I am NOT from this town...

therapist: Well m'aam, this question isn't about this town...its just a sentence off this test in front of me...can you repeat the sentence i just told you??

Mrs. Ringer: silence

therapist: Okay, well...then what did you do yesterday?

Mrs. Ringer: I do believe i was sitting on my tail a-hollerin' like crazy...

therapist: umm...okay...How long have you been here?

Mrs. Ringer: Long enough to have a STROKE!!!!

therapist: What did you do before you came to see me today?

Mrs. Ringer: Oh I don't know...OH WAIT...I was hollerin' with my tail...and OOOEEEEEEOOOOOOEEEEE I am STILL hollerin' with my tail....can you help my tail??




*patient's name has been changed

waiting.

I remembered him on the drive back to WV yesterday. I was on my third sermon of the drive, a talk on the Song of Solomon from Mars Hill Church by Pastor Mark Driscoll. Something inside me snapped…and as I reached back for the quickly-emptying box of Kleenex, I remembered him from my visit to the nursing home last week.

My attending grabbed my arm and pulled me into the doorway of one room in the third wing on the first floor. We were making rounds & had just finished with a lovely 92 year old Italian woman when I was yanked into a quiet room in the middle of the bustling hallway.

The residents, as I wrote before, were a bit unruly because of the Halloween party that was to follow dinner. The staff was busy in the dining room, stringing orange & black streamers across the ceilings and stationing CMA’s at the cookie tables to ensure their Diabetic residents didn’t indulge themselves into a sugar coma.

From inside the room, though, the squeak of wheelchairs & big-tongued babble of denture-clad residents seemed miles away. And aside from the low hum of oxygen tubes, I might have guessed I was in an entirely different building. I was captivated. By the quiet. By the tubes. By the white net crib the body before me rested in…

The attending told me he was only 59. The patient had been under his care for at least two years—and hadn’t changed a bit since then.

My mind raced. FIFTY NINE??!?! TWO YEARS IN THIS BED??? NO CHANGE??

His skin was smooth, almost glowing. Women would pay money for that natural glow. A thin white tube hung above the netting slowly dripping liquid protein into his deteriorating stomach.

And there he lay. Silent. Still. Unaware of the chaos that ensued around him, just feet from where his sunken face rested.

Apparently he had suffered an unexpected stroke…and just never recovered. I asked about family & the attending shook his head slowly—no one had come to visit this man in the white netted-crib. And when I was updated on his medical condition, it was quite clear there was no chance of improvement.

I thought about the tears running down my cheeks. And then I cried for him. Because the truth is that the brave staff who bathe him, who change his liquid-protein, who rotate his bony body to avoid pressure sores; the brave staff who walk by his room countless times each day, they won’t notice when he is gone. And the truth is that I won’t either. We all, sadly enough, are waiting for him to die.

And then I cried some more. Because at this point in his life, he is alive…but he isn’t living. He doesn’t cry. Doesn’t grimace. Doesn’t laugh. He doesn’t converse. And in every way is playing a non-contributory part in this society.

I’m reminded of the lyrics of the song “Somebody’s Baby” by Jon Foreman:

She yells, "if you were homeless

Sure as hell you'd be drunk

Or high or trying to get there

Or begging for junk

When people dont want you

They just throw you money for beer."

Her name was November

She went by Autumn or Fall

It was seven long years

Since the Autumn when all

Of her nightmares grew fingers

And all of her dreams grew a tear

She's somebody's baby

Somebody's baby girl

She's somebody's baby

Somebody's baby girl

And she's somebody's baby still

She screams, "Well if you've never

Gone at it alone, well then go ahead

You better throw the first stone

You got one lonely stoner

Waiting to bring to her knees"

She dreams about heaven

Remembering hell

As a nightmare she visits

And knows all too well

Every now and again

When she's sober she brushes her teeth

She's somebody's baby...

Today was her birthday

Strangely enough

When the cops found her body

At the foot of the bluff

The anonymous caller this morning

Tipped off the police

They got her I.D

From her dental remains

The same fillings still intact

The same nicotine stains

The birth and the death were both over

With no one to grieve

She's somebody's baby...

And that is just it. HE was somebody’s baby. And when I walked into that room, my faith & the limitations of this miraculous field we call medicine engaged in a head-to-head battle. My faith telling me that he should be loved, that every human being has the *right* to live…and medicine telling me that with no chance of recovery, this man that once was is no longer…

So where do we define life? And furthermore, what do we define it by? The ability to cry? To engage in conversation? To respond to questioning or small pokes or painful pinches we call stimuli? The ability to eat independently? Or blink? The ability to move at all? And where do we draw the line? Two years? No improvement? No response? No chance of a hopeful recovery?

I’m still left pondering. When I get around to writing my own Advanced Directive, I know I don’t want to be stuck in a white netted crib for the rest of my life…I know I don’t want to be pushed into a side room and rotated every two hours to avoid pressure sores…I know that I’ll just want to go home.

My instinct is to think the same for all of my patients as I do for myself…to think that this man in the white netted crib would also just want to *go home*. But such is the conundrum of medicine: each person is autonomous…and as a physician, I have to respect that, no matter how difficult, tainted, or burdensome their care may be.

And so fell my tears. Tears for the life that is frozen in time—for the man in that white netted crib that no one is missing. Tears for the life that seems wasted…the years that have passed without so much as a moan. And tears for the mind of this man…because those fancy beeping machines can’t tell us what he is thinking, or wanting.

And so lays this man. Surrounded by tubes and beeping machines that give us no hint as to whether or not he will ever wake up, much less his awareness of the Halloween party down the hall. Surrounded by the echoing sounds of squeaking wheelchairs and the big-tongued babbles of denture-clad residents. Surrounded by a white netted crib and freshly sterilized sheets.

…and perhaps, too, surrounded by angels...waiting patiently for the commencement of his journey home…

I've been tagged!

(1) I have a hair fetish—and perhaps a slight bit of OCD-esque tendency when it comes to stray hairs on furniture, clothing, or things. So beware…I WILL come after you with a lint-roller (one of which I carry in my purse) if I find stray hairs on you!!

(2) Chai tea is my favorite J Only three types of chai have topped my “best ever” list: “MyChai” made organically from local ingredients around Mt. Bachelor in Bend, Oregon, some magical mix @ the Service Station in Spokane, WA, and what I’m kindly referring to as “hick chai”, found at the only coffee shop in Lewisburg, WV. My morning consumption has been known to exceed two cups—after which I leave for work with a roaring headache from the sugar rush…normally though I still with ½ cup & splurge on the weekends ;)

(3) I love office supplies. My favorite stores include Staples & Office Depot (although I am partial to Staples) and drool over any stationary stores’ pen aisle. Buy me a new pack of highlighters and I am one happy clam :)

(4) My dream job as a child was to be a neonatolgist (i.e., preemie doctor) with a side job working at Sea World, riding Free Willy into the wild blue abyss. (And I’m not kidding). So far, the former isn’t out of reach…but since Free Willy died a few years ago I’ve let the latter slip through my grip

(5) I want to charter a sailboat in New Zealand and sail into the sunset with my husband :) I grew up sailing my Grandpa’s boats…and have dreams of a New Zealand sailing trip someday.

(6) I have never eaten liver (although Jon is a fan of it)….but I have consumed the likes of: shark, crocodile, frog legs, sashimi, boiled bananas, raw seaweed (straight from the ocean!), salmon smoked by a real Indian chief!, head cheese (a man made me eat some in the commissary one day), cow tongue, pigs feet, spanish chocolate made from real cacao & chili powder and many more delicacies :) YUM! (okay not really…I almost gagged with all of them!)

(7) I never thought I’d get married. Seriously, I didn’t! I imagined myself as an old lady with lots of cats (even though I don’t like cats), practicing medicine & coming home to a house of purring critters…God changed those plans real fast, yes?

extra credit (8) I have a slight obsession with list-making. I finally found glorious [insert angels singing] iGoogle where you can customize YOUR OWN ONLINE LISTS and was instantly in list-making-heaven. If there is ever any suspect of my saneness, just ask me if I have a list in my purse...if I don't, you'll know I really am crazy!!!

{okay, I know I'm supposed to tag other people...but I'll make this voluntary :) }