True Blue

I sometimes wonder, do human beings really,

Really want to be made happy? Really?

We say we do, we get all touchy feely

Fluffy-pinky, winking and laughing hollow

Laughter after drinks and intercourse.

Of course we do!

     (But really?)

  I don’t mean wanting

The way a man wants ice cream after dinner.

But more like hot red beef wants salt, like fire

Wants wood, like heart wants pulsing blood, like blood

Wants fire and burns for battle, broil and brawl.

Like home wants ruddy ember glow, like farm

Wants wet warm springing days of living green,

Like crops want rain, and farmer crops, and drops

Of dew coalesce on thirsty emerald leaves

For love.

                Gloomy blue gray days of moping

Hopeless funk, portend our self-important

Snobbish refusal of color.

                                             Until one day,

A rescuer! Flashing fierce St. Elmo’s fire, singing

Metallic odes on jaw wire; lightning shooting

Neon pain, a feast of feeling, knocks me

Reeling, electric blue bright sparks impart

The truth of Blue.

       A toothache is,

          at least,

real.

Old People Are More...

My two favorite patient populations to work with have always been old people and children. Of course I have always loved interacting with kids, even when I was one myself. In some respects I still am one. It keeps me sane.

I was surprised when I started working with old people in my medical rotations to find that I really liked them. Perhaps they appeal to me because of their extreme vulnerability, which in America is often pretty great and is getting worse. Children are almost never left unprotected in the healthcare system. Old people very often are. If I can interact with an old person who feels abandoned, unvalued and unloved, and just for a few minutes or an hour or so I can listen to their story and let them know that they are still worth my time and patience, I like to think that I am fighting back against the hatred that society has for the ones who no longer make money.

But vulnerability is not the only reason they appeal to me. Underneath the vulnerability I see something else, which I am not sure how to describe. The only word I can think of is "rootedness." They are not less than the young patients, they are more. Old people have already become. I am explaining this very badly.

My fiancee and I agree that in general there are two kinds of old patients. There are terrible old patients and there are awesome old patients. There are no average old patients. (This is not including patients with dementia or Alzheimers or some other primary mind altering condition. They are a different story altogether.)

Once in the ER, on the exact same day on opposite sides of the hall I had two patients, both older gentleman, one in his late 60's the other in his early 80's. One had come in for a fall in his garage, and spent his whole visit complaining about how much pain he was in, and how terrible the service was, and how he had to tell his story so many times, all the while explaining how tough he was and what a high pain tolerance he had. I was examining him and he winced and screamed like I was stabbing him every time he saw me come near where the injuries were.

The other gentleman, the older one, had cut his leg with a chain saw a week prior and had calmly driven in to the hospital and gotten it stitched up (bad call on the part of whoever stitched it). Now it was closed, but there was a huge, angry, red abscess cooking in the wound pocket which had not been allowed to heal from the bottom up as it should. His whole front thigh was in pain, but he was sitting upright, quiet, patient, chatting and telling stories of his exploits and the strange things he saw back in the War. We squeezed every drop of pus out of that wound by force and then mashed on it until there was not one little pocket left undisturbed. He turned a few shades paler (he was a black gentleman) but then he looked at the huge glob of pus and clot we had expressed and jokingly asked whether he should give it a name.

Old patients are not less of anything than their younger counterparts. They are always more. They are either courageous beyond belief, or whiny beyond belief. They are either interesting in ways that no younger person could ever be, or incredibly dull. They are either utterly loving and self-giving, or they are exasperatingly selfish. The elderly gentleman with no teeth, rheumy eyes and unsteady feet is still more courteous and gentlemanly (and charming, my fiancee would say) than any suave, cultured man of the world. The dirty old man is more lecherous than any horny teenager would ever dare to be. That peaceful old lady with the curly white perm is more completely unselfish in her every thought than I have ever been at my most heroic. That other lady in room three is more vocally and rudely inconsiderate than I have been since I was a baby.

Perhaps my fiancee and I have this perspective because we see them under stress. The stress may reveal traits that do not show in day-to-day life. However, I think there is another reason. I think that old people live in extremes like that because they have spent their whole lives becoming that thing or the other. They have either been practicing strength and courage and courtesy and become very good at it, or they have been practicing weakness, manipulation and whining their whole lives and have gotten very good at that.

Whichever the case, it does not change how I treat them. If anything, I have to put more effort into the whiny patients. I don't know their whole life story (although I probably will if I don't watch out) and I don't know what they have been through. I don't know what they are afraid of. They probably don't know what they are afraid of, and if they have not faced up to it in the last 70 years or so, odds are they won't do it in the time they have left. I pray that they do, though. Even at the end of our lives, all of us are still becoming. Right up until the very end, change is still possible.

At any rate, it makes me take a good hard look at my life. I ask myself, what kind of old person am I becoming? Am I becoming a holy terror? Or am I becoming that awesome old dude who can crack jokes while getting an abscess drained without anesthetic? It is worth thinking about.

The Power of the Powerless

I remember reading a story about a rather wealthy Indian lady who volunteered to work for Mother Teresa for a day, back in the years before Mother Teresa was an international celebrity. This Indian lady arrived at the clinic, which was a house for the dying, and was instantly overwhelmed by what she saw, heard and smelled. I know how she felt, too. Walking into a place like that is an instant sensory barrage of horror and evil. The evil, ugliness and pain are all very sensory phenomena, with their accompanying groans and screams, odors and wounds. The peace and love that the patients experience for the first time in their lives is much harder to see. The sight of raw flesh of a beggar who got run over by a truck is easier to notice than the fact that his wounds have been painstakingly cleaned of dirt, maggots and infection;  emaciated arms and ribs of a man who should weigh 70 kgs but instead weighs barely 30kgs hide the fact that he has just received the first good meal of his life, spoonfed by a woman who has dedicated her life to loving him; the smell of a human being in total kidney failure when his uric wastes are oozing through his pores on his skin disguises the fact that he has just been bathed today for the first time in his life. All of these things are a shock to the system. Even a trained and experienced medical practitioner can be overwhelmed walking into such a scene. Where do you start? What do you do? But this rich lady was a lay person, just an upper caste woman who had a kind urge and decided to volunteer for a day. I can only imagine what she must have been feeling as she stood there, surrounded by the obvious horror of human suffering. She must have been terrified, bewildered, filled with sorrow and helplessness. She must have wanted to turn around, run right back out the door, and never come back.

Fortunately there was something else at work, subtly, quietly, faithfully hidden under the obvious horror. Mother Teresa took this lady by the hand and led her to the most heartbreaking patient of all. A newborn infant was lying on a cushion, alone. Perhaps his parents had abandoned him, or perhaps they were dead. This was not a healthy baby. He was lethargic and emaciated. He did not cry or flail his tiny arms around. He did not startle the way a normal baby should, or grasp with his hands, or even suckle when a nipple or finger was put to his lips. He just lay there with his arms and legs spread out limply around him, breathing with the halting, abrupt, shallow gasps of a baby for whom simply breathing takes too much energy to be worthwhile.

Mother Teresa led the rich lady to this baby and told her simply to pick the baby up and hold him and love him for the few minutes or hours he had left to live. The rich lady protested that she couldn't possibly do that. It would surely break her heart. Mother Teresa only repeated her invitation, and went about her work. Left there in front of the dying infant the rich lady made a choice. She reached down and took that baby in her arms and held him. For the rest of the day she did nothing but love that baby as hard as she could until finally he died in her arms. And her heart broke, but not with anguish as she had expected. It broke with love.

I read this as I was in the first half of the SF medic training course, and it forever changed my view of medicine and healing. As healthcare providers we are trained to save lives. Our thought and energy are bent on staving off death for as long as we can, prolonging life, reducing pain, preventing or mitigating disabilities. All true healers have this goal, but all of us inevitably face the truth that our patients are going to die. Put it off as long as we can, prescribe what we will, in the end death will win. We can only delay it. Sometimes we can delay it for years. Sometimes only for minutes. Sometimes the patient is already dead, but their body just hasn't figured that out yet.

Faced with this truth, each health care provider, from the lowest EMTB to the Surgeon General (who generally does very little surgery from what I hear) has to find his own way of dealing with it. Some choose to ignore it. Some simply shrug their shoulder and move on. Some stop caring eventually. But in Mother Teresa's radical and almost unforgiveable request I believe I have seen the only true way forward. We must look deeply into the horror of death and see past it to the subtle, patient, silent work of love which is operating underneath the horror and pain, stronger and older and wiser than them. In the truly authentic Catholic approach to healthcare there is the acknowledgment that the patient will die, and the deeper knowledge that love is stronger than death. Even if the patient will only live for a few seconds, those few seconds can be lived with dignity. They can be filled with life and love and peace, if someone is brave enough to let God use them to be that gift. Such moments are never wasted.

All of this went through my mind when I saw this video by Tammy Ruiz a Registered Nurse who specializes in Perinatal Bereavement and Perinatal Hospice. I am not at all ashamed to admit that I couldn't watch the full video without tears in my eyes. The work she does is beautiful, heroic and necessary, and alas, all too rare.

Please watch the video and pass it on particularly to any medical proffessionals who are involved in birth and perinatal care. Pray for Mrs. Ruiz and the continuation of her vocation, which is truly a call within a call. Take the time to celebrate life in whatever way you can. This is a solid, concrete answer to the culture of death and a joyful affirmation of the infinite value of every single human person, no matter how small.

Go here to read Mrs. Ruiz's own words on her work.


(The Title of this post is taken from the title of the amazing book by Christopher De Vinck.)

Shadow Flower

You dwell so much in shadow; at times it seems
As if there is no hope, no peace, no strength.
And days and nights grind on in weary length,
Grueling days, and nights of restless dreams.
For rent and gas, utilities and counseling fees,
You last from one hard-earned check to the next,
No friends close by, not even a friendly text,
Living on Zoloft and lonely mac & cheese.

But in God’s eyes your soul is so much more,
A flower unseen that blooms in shadows dim
Seen only by Him and those who see like Him.
Instead of petals bright, your scent is your allure.
Flower of the King, sought out by scent alone
Hidden deep in shade, but healing balm
For those who seek you out. A quiet calm
Is growing in your heart right now unknown.

And through all time and space your heart is one
With all who suffer: future, present, past;
From the first tear ever shed, until the last,
With all who have endured the ache and done
What was required of them, again and again.
The dogged strength that falls back in the pit
And stubbornly from the mud, refuses to quit,
This silent solidarity of hidden pain.

You shadow flowers. Flowers of greasy smears
Of tiny fingers on dirty window glass
Looking out on fields of human trash
Too ignorant to see the need for tears.
Wretches toiling in the bowels of diamond pits,
Drop short-lived flowers of sweat, which bloom in dust
And are trampled underfoot. Flowers of rust
And soot and ash, in haunted chimneys at Auschwitz.

Each flower is precious. All are saved and drawn
Together into crimson teardrop flowers
On Gethsemane’s hallowed ground, the darkest hours
Of all the shadow children. He has gone
Where none of us can go, to be with you.
But in mystery most subtle, He also calls
You sufferers to join Him, as He breaks the walls
And cries, “Behold, all things I make anew.”