Friday, April 20, 2007

dying alone in a crowded room

Fiction #1: Dying alone in a crowded room - rewritten

A steady stream of women, good-church-going women toting Bibles, food and membership directories, carry large handbags and wear carefully selected color-coordinated hats as they trickle in and out of the room on the corner.

The man in the katty-corner room is bound to the bed with tough black fabric restraints. He is forced to strain his neck and twist his body to catch a glimpse of the activity across the hall. This is what he wants to do but each time he tries, the large gun-wielding guard places a resistant hand on the man, untwists his IV tubes, and holds his arm outstretched waiting for his strength to overpower the dying man's curiosity.

This is a different picture then the one across the hall. This is a man alone; no, more alone than alone because he can't even get that far. Estranged from his family he will not take their calls from the nurse's station. Forlorn during his criminal trials, does he seek revenge by denying the right to bear witness to those who still love him? Dying alone with an off-duty officer looking to make extra money for a weekend trip, or to buy a gift for his girlfriend (Victoria's Secret?). Waiting for death to get off work is worse than waiting for water to boil. He glances at the clock on his cell phone - the kind with a keypad and a wireless headphone and sits down again next to the door, peeking across the hall.

I glance too - I glance at everything while trying to absorb something from the continuous stream of jargon that pours out of the attending physician's brain, out of his throat, out of his mouth into the halls of the ICU. I scribble down abbreviations, acronyms, key words to look these things up later - later when I can slow everything down to the speed of the cell phone clock that the sheriff’s deputy keeps watching. The nurse calls me "Doctor" and I hate this - I want everyone to know I know nothing. I want no one to expect anything from me at this point - certainly not the dignity that comes with witnessing death. A group of fourth years with another attending arrive next door and begin talking. I'm watching this - watching my inevitable life as it has been played out for students time and time again unfold 10 feet away. I glance back at the lab data and listen. Autoimmune disease, antibodies against the kidneys, kidney failure, leads to anemia - need transfusion, medication, maybe a kidney transplant. Could die - will die - without this treatment.

Another stream of women leave the room - this time they are accompanied by tidy men wearing button up shirts tucked into pleated khakis - no ties. Three of the men have cell phones clipped to their belts. One of the men - a large self-important man with graying hair and a bushy, New Jersey style - or maybe Long Island style - mustache, stops at the nurse's desk and walks over to the unit station - the head nurse (don't ever sit in that chair, don't ever use that computer - that's all I've been told about the head nurse). She looks mean, like a substitute teacher in third grade. The man with the bushy mustache squeezes her arm and says that she is doing a great job. The other men and the new set of women turn without a word and the group heads out the double-doors that automatically open from this side but require a code or a phone call from the other side.

Now is our chance. The room is rarely empty of visitors - always crowded with equipment, nurses, and women with handbags and matching hats and, of course, men with mustaches having conversations amongst each other in hushed tones near the door - blocking the door from the curious gaze of the dying prisoner and his constant guard, the attending and myself, and the hawkeye of the unit nurse zooming in from down the hall.

The two of us move into the room and I see the man for the first time. I notice a large red poster on the wall. It reminds me of a T-shirt for a 5K run or an advertisement for a blood drive. On it, a drop of blood with arms and legs is holding his hands up with his palms pointed out towards the viewer - fingers spread to say "STOP!" A white conversation bubble from a comic strip reads "NO BLOOD". The little blood drop looks like he would rather be wearing sweatbands screenprinted on the front of a runner's shirt, but this current gig will have to do for now.

The man looks tired - no that's not quite right - he does look tired but he also looks like he's in pain and further from peace than he's ever been - further than his religion - which he clings to in the face of death - ever promised him he would be during this life.

I notice a red bracelet on his right arm emblazoned with the same words as the poster, "NO BLOOD". He knows he is deteriorating, the structural components of his body pour out of his urine signaling the end of his kidneys. His oxygen mask is strapped to a slightly blue face - another face with a bushy mustache but amazingly clean cut for day 5 in the ICU. Struggling for air in between words, he answers questions and asks his own - questions that indicate at least the desire to live and the hope of improvement, as well as the understanding of what needs to be done in order to survive.

I look at his left hand - something I do a lot around other men now that I'm married - and I see the gold band on his ring finger. I wonder if his wife fights this, if his wife begs for the clarity of desperation and love that often wins out over irrational commitments and unchallenged resolve. I hurt for his wife more than I hurt for him and feel guilty. I think of a saying I heard somewhere..."Life is for the living" which resolves my guilt for displaced empathy. Would she do the same thing? Would her own fear of death and desire to live, to survive, surpass the promises to a God she has made with her husband? None of this matters because the visitors stream in and out constantly.

They hover around us as we listen to the heart, to the lungs and monitor organ function. There is no clarity, no time for emotion, no time for the looming loneliness and sadness facing his family to ever enter this room, this decision. The church members constant presence avoids this with baked goods and hugs for the wife and for the nurses. Talks of nutritional supplements and the power of prayer with the patient. Holding hands, a constant vigil against the reality of death. A constant guard against the right to die with dignity in old age, to make decisions based on love and partnership with family. There is no room for what-ifs, no time to consider transfusions. The crowded room fills with a constant resistance against the curiosity that creeps up as the reality of death sets in. Dying alone in a crowded room - guarded against the alternative, protected from the demon, the Satan that is a transfusion.

Praise God that his wife does not have to have her 40 year old husband back for another 40 years! Praise God that this beautiful man sits gasping for air on a ventilator! Praise God that this wife will cry alone at night! Praise God that this man will never fully comprehend he had a choice! Praise God for baked goods and hushed discussions, and church membership directories to keep the room in the corner full at all times! Praise God for this, for he is Holy. Praise God that his kid gets to experience death so young!

Emphasizing the need for a transfusion, my attending steps out of the room and I follow behind as a new group of handbag women and mustache men move into our spot. Holding his hand they comfort him while one makes small talk with the nurse who has arrived to check vitals.

As we move down the hall, the attending says to look this disease up and I write down the acronym in my pocket-sized notebook. Hurrying along, I glance into the room katty-corner across the hall. The man in restraints is propped up in bed. He glances over at me and then returns his gaze to the stream of visitors with cellphones clipped neatly to their pleated pants. The armed guard sits in his chair flipping through an issue of Maxim.

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