By Cynthia Stock
A cadre of ghosts populates my forty-three years of nursing memories and creates an extended family of sorts, a congregation of souls. They appear in images of an intimate moment shared, a last breath fluttering into oblivion, a backrub to withered skin, a final word of good-bye to a family, or just me, alone at the bedside listening to one of them breathe.
I watched the lean, muscled young man peer into his father’s room. He wore loose fitting shorts, an NFL jersey-jacket, no jewelry, and a tousled head of mini-dreads. A pair of white and red Jordans housed the over-dimensioned feet of a growing teen. His skin glowed, a mix of chestnut, gold, and honey giving off an almost visible warmth. If I said he was African-American, the words might elicit a thought of prejudice, but if I said it, I did so to share how this young man felt like a son, like my son, regardless of who he was or how he looked. Because of that, I had to find the right words for the moment, words that would not further his pain, but help him survive and grow from the loss of his father.
I looked in the same direction as the young man, trying to imagine not just what he saw, but what he perceived. An inert remnant of a once robust man, his father competed for space in the bed with pillows, foot boots, and a towel wrapped beneath his neck to catch the saliva leaking out of his mouth. He rested, motionless, like a mannequin, except for the artificial breaths pumped into his lungs by a ventilator. Swish-click-sigh. Swish-click-sigh. The sound shattered the silence in a room infected with the specter of death. Chapped lips, coated, but not cracked or bleeding, surrounded the breathing tube, like a kiss of longing, soliciting oxygen, and thus life. The chalk white trace of a dried tear angled away from the man’s right eye. A pool of saliva quivered at his lips, disturbed by each cycle of the ventilator. I planned to suction the excess, something that could never be done quietly, before it defiled the man’s face as his son watched.
“Pull a chair up if you want,” I said. The suction hissed. Thick pink-tinged fluid scuttled up clear plastic tubing into a wall canister.
The young man pulled a spartan plastic chair with a pencil thin metal frame across the floor. It issued a noxious screech.
The face of the man in the bed never flinched.
The son sat, hunched over with his elbows on his knees. “I didn’t see much of him, didn’t know him at all. I feel like I need to do something to honor him.”
My own son never knew his father, because I never did. Headstrong and oblivious to all that was to come, I never imagined how important the physical being known as “father” could be. Playing soccer, half-assed tossing a football, doing yard work, stoking the flames of a Weber grill did not make me a father.
The young man’s eyes brimmed. He wiped away tears and struggled to be a man who didn’t cry, but the eyes brimmed again and left glistening trails down his cheek, prisms of color produced by the recessed lights in the ceiling.
In some ways, I knew the young man’s father better than he did. Typical of virile young men unprepared to be humbled by physical imperfection, his father lived in denial. After a diagnosis of hypertension, when the man ran out of meds, he never refilled his prescription.
I knew the result. In a different time and place, my stepfather stood to get some Tylenol for a backache, shouted at the shock of such pain, and died before he hit the ground. He never knew what hit him. The surgeon said it was the biggest aneurysm he’d ever seen.
Perhaps because of his age, the father survived the ambulance ride, the surgery, the extended time on the ventilator, the failure to awaken: Survival without recovery, the ICU nurse’s worst fear. I looked at the man and his son, saw the likeness in their eyes, the same jawlines. I buried all the indignities the man suffered and focused on the child left behind. Holding on to the side rails, I squatted on my aging knees to be eye-to-eye with the young man. In a world constrained by political correctness, I wrestled with the urge to put my arm around him. He looked from his dad, to me, to his dad, to me.
“Just take care of yourself.”
Those words don’t sound profound today. But when I said them, I meant them. What else could I say to someone about to lose someone, something, he’d never known? The family discontinued life support. The man died. I hope the boy honored him. I had seen enough aftermath of loss to believe he would.
The music of the bagpipes embraces sorrow and hope.
I learned this at the funeral of one of my long-term patients. When he died, I didn’t grieve for him. I celebrated his liberation from a disintegrating body, the result of a surgery gone bad, not malpractice, but Murphy’s law. My grief belonged to his wife, who over the weeks of her husband’s dying, became a friend through our love of books and our sons. Some days before a thorough condition update, most days after, we’d discuss books we’d read and recommended, books we hated, and the evolution of our sons into men. Hers stayed close, mine labored to carve out boundaries between him and his stubborn, controlling mother.
I watched the husband turn yellow from too many blood transfusions and a failing liver. His incisions necrosed. It seemed every day I was at the bedside, the surgeon came in and cut away bits of dead tissue from the man’s chest and legs. Snip. Snip. Snip. Then, he spoke with the wife. I eavesdropped.
“Well his white count is down. If we can just wean him off the ventilator. I think there’s hope.” Snip. Snip. Snip.
The cacophony of the surgical scissors overpowered the baritone lies of the well-meaning surgeon. I knew how this would end. Yes, I believed in miracles, had even seen a few. I believed in not taking away all hope. But I knew the man’s wife, knew the worlds of words in which she travelled, knew the depth of her thoughts.
The doctor left the room. I assumed a broad stance, arms at my sides, letting her know I was ready to listen. I wanted to fold my arms across my body, armor myself against words I knew needed a response. She walked over to me. We faced off. I noticed her isolated gray hairs, an amateurish application of blush, lipstick wiped thin by a nervous tongue.
“The doctor said he’s getting better, that his incisions look better, that if we can just get him off the ventilator and out of bed, he’ll turn the corner,” she said. Then she recited the meaningless lab values the doctor gave her, tangible proof that her husband would survive. “I know he’ll be okay.”
Snip. Snip. Snip. The sound echoed in my head. After countless discussions with families about death, it never came easily. I remembered the day Mom called to tell me Dad died. It was my birthday. The day my stepdad died, the phone rang as I stepped out the door to go to work. Death always managed a dramatic entrance.
I vowed to keep the man’s wife grounded in reality without destroying all hope.
“The patient the doctor described to you is not the one I see in that bed. Look at your husband. You know him better than anyone.” I allowed myself to put an arm over her shoulder and turn her toward what was left of her man.
I sat towards the back of the church on the aisle so I could make a quick exit. People filled all the pews. I watched ushers seat the family in the front row and listened to praise and prayers for a man I knew through his wife and children. The service ended. The bagpipes played Amazing Grace. The sound broke the dam of my restraint. I cried. A lone, kilted musician led the family out of the chapel. Then it happened, a moment I could not escape. The procession stopped at my pew. The wife reached for and squeezed my hand. Through her touch, I heard her message. It said “Thank-you. Keep doing what you’re doing. You are making a difference.”
She was a little red-haired girl. I didn’t have any children at the time. When I saw her face and the spiral curls surrounding it, I wondered what I would do to protect a child of mine. No one had protected her, not her father, not the legal system, no one. Swelling turned a perfect face into a bloated Ganymede. A once pert nose surrendered to fluid filled tissue. Lids, puffy, as if she had been crying, clamped down on blue eyes. Or were they green? The charge nurse assigned two nurses to care for her. Unheard of. I spent twelve hours running back and forth to the blood bank, not for one or two units, but three or four at a time. I lost count of the stairs I climbed, unable to risk the little red-haired girl’s life, waiting on a tempestuous elevator. My colleague, a more experienced nurse than I, charted and passed meds. We double-teamed any physical care, turned the little red-haired girl as if she were a delicate crystal and one false move would crush her. My colleague and I spoke more with our eyes than with words. The day ended. I sat in the locker room, elbows on knees, summoning a last vestige of energy to make it to the car.
I came back after a few days off. The little red-haired girl was gone. My colleague stopped me in the locker room before I went to get my assignment. “They tried to take the ET tube out. It didn’t last long. But she spoke. She said ‘My mother shot me.’”
I still think of the little red-haired girl when I read Peanuts. The memory, a sucker punch, reopens a heavily scarred wound.
I know surprise and pleasure lit up my face when I recognized the young man walking toward me in the ICU. He wore sandals, a crazy print shirt, and a well-manicured lawn of frizzy hair. Before this, I’d only seen Joel in maroon scrubs, a triangular patch with his school logo on one sleeve. Joel belonged in a group of nursing students I taught. Every year more men entered the profession. Joel represented the type of nurse I hoped to nurture. He addressed the science of the body with the art of treating each patient as an individual, a true people person. We embraced.
“Joel what are you doing here?” I hoped he had dropped by for a social call or to ask about a job.
“They tell me John’s coming here from recovery room.”
Despite the Stonewall riots of ’69, gay rights remained an issue flying under the radar. As my student, Joel didn’t need to out himself. His distinct, clearly defined persona made it unnecessary. His comfort with his own being made everyone around him comfortable. I knew John was Joel’s partner, knew they were monogamous, knew there was an illness prevalent in the gay community labeled the “gay plague.” I had no experience with it. Denial, a therapy not limited to patients or families, allowed me to offer the false reassurance I probably taught Joel to never give. “I think I’m assigned to his room. I’ll take good care of him.”
I did take good care of John. I controlled his pain, bonded with his parents, and allowed my professional boundaries to waver. I comforted Joel, not just as a nurse or ex-teacher, but as a sister or a friend. John’s parents bought me a Christmas gift, a shoulder bag of shiny faux-leather, something I never would have bought, but treasured with pride.
On the day the surgeon rushed John to exploratory surgery, Joel, John’s parents, and I huddled together. John’s parents believed in miracles and prayed. Joel and I abandoned the stronghold of our denial. Our circle of strength could not ward off the inevitable. John died twenty-four hours later, cause of death, a mystery.
It didn’t have a name and wouldn’t for a few more years. It didn’t matter. I’d had a special family for many days and lost a part of it. Science and ingenuity found a treatment for AIDS. With it, I found hope and a new resolve. But the loss I felt for my temporary family and an entire community never disappeared.
The first Christmas of my first “real” job, I knew I would have to work. I didn’t know the celebration of this birth would forever be linked with the first death of a patient in my care. He resembled a street weary Alan Bates. Greasy hair gathered around his face, but I could tell it grew thick and curly as Bates’s had in the controversial Women in Love. The man was a professor at a local university. In better times, I pictured his hair shining in obsidian waves, a tweed jacket with suede covered elbows, even a pipe.
In reality, blood shot eyes scanned the unit in panic. A sallow hue ended the movie star likeness. Metal side rails kept the man contained. He perched elbows on each side of the spartan cart, what then passed for a state-of-the-art ICU bed. A mixture of dried blood and vomit trailed down the corner of his mouth. His pulse and blood pressure jumped from moment to moment. As restless as he was, I couldn’t keep a patient gown on him, so he writhed and twisted about the cart in boxer shorts. I was new to ICU, but smart enough to recognize a man leaning into the black hole of death. I phoned his attending, a new internist on staff. The compact, efficient man sped into the unit before I had a chance to hang up the phone. I voiced my concerns, dared to suggest things that needed to be done, fantasized about the gratitude bestowed on me by a professor, who appreciated my tenacity in turning his life around.
“There’s nothing more we can do,” the doctor said, dispelling my reverie.
I noticed the professor perked up. He heard the same words I had.
As the doctor hurried away to manage another crisis, he asked, “Doc, can I have a cigarette?”
The man’s heart devolved into chaos. He died before I would be forced to deny his last request.
One moment, backed by science and good intention, I felt empowered, unstoppable. The next, I felt humbled and defeated by all that was out of my control. Outside the microcosm of the hospital people connected, celebrated the season, and took living for granted while a man died alone, watched over by a nurse whose name he didn’t even know. December 25th, 1973, I lost my first patient and my naivete. December 25th, 1973, redefined Christmas and what it meant to be a nurse.
In retirement, I still see the members of my family-of-sorts, gathered in rows with me standing before them. There is Mike, with whom I shared a macabre dance while he fought to maintain his footing, then slumped, before allowing me to lift him into bed. He taught me about pride and dignity. There is Tom, who told me what to do for him when he was ready to die, to whom I sang as I prepared his body for the morgue. He taught me death was not something to fear. There is Eugene, who I helped hide his tubes and drains and catheters so his little daughters could sit on his lap one last time. He taught me about parenting.
I am a supplicant asking those I knew for forgiveness because I couldn’t do more, blessed because they permitted me to enter their lives when they were most vulnerable, cursed by the loss of them.
Time dusts the details of the memories with a haze, but the feelings remain visceral and clear. It only hurts when I remember. I know I would do it all again.
Copyright Stock 2020