Tuesday, September 08, 2009

Holes, part two.

They don't tell you these things when you're in school. They don't tell you these things when you start out. You have to find them out for yourself, the hard way.

Two deaths this week: an old patient and a young coworker.

The old patient was the first person I'd ever put Buck's traction on. She and her partner had been together for something like 70 years and were both doctors. They were doctors at a time when women either weren't doctors at all, or were doctors in something nonthreatening, like pediatrics. Not these women; they went into internal medicine and orthopedics and proceeded to kick ass in the research and practice departments.

They showed up after my patient broke her hip in a fall. They stayed for a week after her hip replacement, then went to a rehab closer to home. They sent Christmas cards every year, thanking the nurses for their work. I was a brand-new nurse when I cared for her, and I learned a lot: like how Buck's should be put on, what output on a CHF patient looks like, how to prevent shear injuries in moving orthopedic patients. Every time I get a CHF patient, I think of her, still, seven years later. That is her life-after-death, and I think she'd like it.

The young coworker?

He was younger than I am. Most of 'em are, these days, but it doesn't lessen the shock. He'd gotten bloated over the last few months and had seen a doctor about it, only to be--finally--diagnosed with by-then-far-advanced liver cancer. He died barely two months after diagnosis, sadly compos mentis to the end and well aware of what was happening. Rumor has it that he was giving tips to the nurses' aides that took care of him up until the end.

This is what they don't tell you: That, if you have nobody at home who's willing to listen, or nobody at home at all, you'll walk around feeling the hole.

Remembering people to somebody else keeps them alive. It does what we fail to do all too often. When you can't remember somebody in person, you either drink, or take Vicodin to the detriment of your liver, or you blog. Of the three, blogging might be the least harmful but is certainly the most annoying.

Eventually, it gets to you. I put my hair up this morning in its usual bun and wondered whose obituary I'd read today, rather than wondering what's in store in the marvelous healing and miraculous recovery department. That's temporary, of course; I'll wake up next week optomistic and energetic again, and forget what it's like to wait at the elevator for somebody who's not going to show up.

The bitch of it is--the truly real bitch--is that so few people share your experience. "Someone died," you say, and they say, "Oh, so sorry". It's not the same as saying "someone died" and having the other person say, "was it under your hands? 'Cause that sucks." You realize, the longer you do this job, that you live on the other side of a vast gulf of experience, separated even from your best friends and your parents and your lover.

Well-meaning people try to cheer you up, when what you need is to sit out on the porch and pour one out for the homie who's no longer there. They want to listen, but you find yourself explaining things in too much detail, too carefully, and somehow the sheer raw power of life and death gets lost. It's not the same as it is on TV: it's not pretty, it's not accompanied by a feeling of closure and two thirty-second commercial breaks, and it's sure as hell not done in company of a bunch of good-looking residents.

This, friends and students and neighbors, is the hard part. This is the time when what we do, no matter how much we love it, gets lonely and empty and strange. This is the point at which we survey groups of people and wonder who's going to be alive in a year, simply because we've seen so many young, healthy, old, intelligent, marvelous, funny, grouchy people die.

They all leave holes in your soul. Some of them are big holes, some of them are small. Some people you see die and feel nothing but relief and thankfulness. Others, you wonder why the hell the good not only die young, but die young of horrible things. Eventually, you look at your own self, not with shock that your essential person-ness could've survived so many leavings, but with wonder, at how long it seems to be taking to disappear.

The human brain is an awesome thing: I mean that in the original sense of "awesome". It is also a terrible thing: ditto. The human soul? Is equally as awesome, equally as terrible, equally as deserving of respect. And it is, thankfully, infinitely more elastic than the brain.

If what happened to my self had happened to my brain this week, there would be no way I could've gone to work today.

Those who are not here any more eventually, and irreversibly, define what I am.


woolywoman said...

OH crap. Worse than having no one at home is having someone at home who says " well I had a bad day, too"

I think the old doc would love that you still think of her when you care for patients. I'm sorry about the friend. They are all younger than me, too.

Crabby McSlacker said...

Damn, I'm so sorry. Both sound like tough losses. Thanks for sharing these inspiring souls with us so that their influence may continue to ripple outward.

topo said...

Hang in there; your blog inspires me and keeps me wanting to be a nurse. I'm glad you write.

danielle said...

What an honor to have known two such brave and smart women! And what a way to honor them - to remember the real life lessons that they taught you!

As for your other friend - he went quickly - which might or might not be a blessing. Only he would know. But the fact that you remember him - and are sharing your memories, is an honor.

What I hate more - when you are sorrowing and trying to talk it out - is to hear "oh, you'll get over it". "IT" is not something to get over...

merinz said...

The holes they leave are hard to fill aren't they.

I am the last one left in my own family and the holes are enormous! No one to share memories with.

Just My 2¢ said...

Crap... Welcome to the somewhat, sort of, maybe, older folks club. Once upon a time, I (at least partly) identified myself by the friends and family in my life. Now, I'm finding that I am defining myself by the people that have gone. Part of the process, I suppose.

Anonymous said...

i think, *perhaps, it's in the air.. i've had those pts (have) that stick in the memory. i think they always will. (i say 'it's in the air' because the memories have all come trickling/flooding back this last week)
sometimes, you just need someone to listen. (don't tell me it wasn't my fault or any other 'calming' things... just. listen.)
*toast to those that have passed

Dr. Alice said...

You should write a book. I have never seen a more eloquent summing up of the spiritual toll that a career in healthcare can take.

Karen said...

Jo, I am a hospice nurse--and I feel that there is a deep still lake in my heart where I store all those who died. I think they are safe there until we see each other again, and I am safe, too , knowing they are at peace. That's just my image of things. But there are days when I want to scream, and I complain to God a lot.

Paris said...

What a beautiful post. Grief can be such an isolating experience. Glad you're blogging about this, your readers are listening.