Wednesday, September 11, 2013

The Struggle For Life

I had never been so close to death before last night. So many things raced through my mind all at once. I began to reflect on the struggles in life that each of us encounters. From birth, we're fighting. Fighting to take our first breaths. Then, some months down the line, we fight with our wobbly legs in an attempt to stand up and walk. During this shadowing experience in an Emergency Department, I've seen many people experience various types of struggles. It's made me grateful and also very introspective on my experiences thus far.
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"CPR. CPR"
We were in the middle of Rounds as the intercom and walky-talkies sounded. The group disbanded as one of the Attendings and some residents rushed to the CPR room. Being the "shadow" always asking for excitement, I quickly followed the group. An African American man, most likely in his early 60's (I missed the details of his case), was lying on a stretcher. The paramedics were giving an exhausted, if not lackluster, attempt at chest compressions. The hospital staff took over, two residents switching off with one another to avoid fatigue. They vigorously pressed into the man's chest. Down. Recoil. Down. Recoil. I began to wonder how this fortress around my heart could respond so readily to the exertion by human hands. Another staff member slowly and steadily bagged. Fluid gurgled back into the tub with each release of the bag. I wondered if he had had a seizure. Perhaps that was vomit coming up into the breathing tube.
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One of my earliest memories of this graceful struggle for life is of sitting with my grandfather on his hospital bed. I remember him being active and engaged despite the cancer ravaging quickly through his body. I must have been four years old. I didn't understand what death was at the time. From that moment, I always remembered my grandfather as being alive. Stories of him conquering tennis courts and providing cars for each of his eight children is how I still see him. I don't remember his struggle. I only remember his strength. After working with family caregivers for dementia patients and hearing of their experiences with "the long goodbye" I'm grateful my grandfather didn't suffer for too long. I'm also grateful he was fully aware of his health condition and able to say goodbye to his loved ones before moving on.
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I had recently renewed my CPR certification for work. Giving chest compressions to a dummy did not prepare me to see the lifesaving technique carried out on a human being. The man was of a sturdy stature, plump around the mid section. I never saw his full face as they shoved the breathing tube into his body. I saw he had facial hair, a dark grey and white beard. A long longitudinal scar was drawn along his midsection. "What type of struggles has this poor man seen?" I wondered.  

"How many Epis did he have? Six? Ok, let's do one more. Check pulse. Everybody off. Let's get another pulse reading. Nothing?"

The resident orchestrating the efforts of so many staff calmly observed, interjected, and deliberated to make quick decisions. I grew to admire her more throughout the night.
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I've always been a very optimistic but cautious person. Always aware of the precious time I've been blessed with and the responsibility I have over my own life. I can readily see the positive in any situation. But the more people I encounter, the more I realize how much I take this character trait for granted. As a research coordinator I do depression screenings and have received some very high scores. It makes me wonder at what point does our struggle become overwhelming? At what point does our human spirit concede to sadness, hopelessness, and despair? Have optimistic people developed a higher threshold that they have yet to reach? Are their coping mechanisms such that they dissolve the opportunity and challenge of potential spiritual defeat? Or does optimism serve as immunity?
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I looked on wide-eyed and hopeful at the quick hands and firmly chirped directions by the third year resident. This night I began to think of death in a different way. Recognizing I had been around death all of my life, but had never been so close to someone struggling for their life. (Or have I?) I made silent prayers and inched around the fast-paced residents and nurses to get a clear view of all the activity. I did my best to stay out of the way and felt utterly useless.

"Do you have any questions?" Dr. A appeared beside me and took a firm gaze over the commotion. He looked satisfied at the hard working crew that was under supervision of the second attending. "No. I'm just...taking it all in I suppose." I had no idea how I would react to this type of commotion. I wasn't surprised to be so calm. I almost felt guilty for not feeling a deeper sadness, but objectivity would be my best friend once I am practicing and helping to save lives. At least that's what I've been told.

I noticed a medical assistant checking her phone as she returned for more supplies to a cart. I began a silent prayer to never lose the value or sensitivity to human life once I do join the ranks of white coats. Sensitive, empathetic, objectivity? It will be an interesting and challenging balance.
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I reflect on how many cries of suffering I hear in the ER during my visits. Echoes of desperation. Of pain and suffering- some self-inflicted, some by the hands of those trying to save a life. I wonder if any of the suffering people are optimists under siege. I wonder where this struggle begins for each of us. How do we cry out? How do we cope? How do I cope?

So many young people pick up a bottle, a needle, or a joint to enter into a temporary, detrimental, and forgetful daze. Recent newscasts of deaths due to 'Mollies' made me sad at the thought of needing to escape. I've had my own escapes in past years but usually within an adrenaline rush on a field or pitter-patter on a treadmill. These days I am more than likely to embrace struggle through writing and prayer. Contemplating the roots of an issue is more fulfilling than hoping to wipe it away for a brief period of time only to have it rear it's ugly head again in a different way. I'm grateful to have experienced life and developed my own more effective coping skills.
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"Do you see that black and decker looking thing? Watch. That's called an IO."
They were inserting an intraosseous line to inject medication directly into the marrow. My eyes darted around the room as the team continued compressions and attempted to squeeze some type of fluids into the man's veins.

"How long has it been? Thirteen minutes? You said they found him like this? Ok, let's do another pulse check. Pulse check please!"

He was unresponsive. I made silent prayers for this man. I hoped he had a family somewhere who would be with him before he entered the cold morgue. I had never experienced this before but I knew they were about to pronounce him dead. The feeling of death hung like a thick cloud in the room. Looming as if awaiting those words to come off the lips of the resident to make a more ceremonial decent.

The strange part was that this man was never alive on that gurney. Despite the vigorous efforts. The quick-paced movements toward needles, syringes, bags. The desperate massaging of different areas on his tormented body, searching for signs of life. Despite all of these efforts everyone knew he was dead. While their efforts didn't show it, there was most likely some doubt he would come back.
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After hearing many medical histories of abuse to our own bodies, I wondered what it would take for us to take charge of our health. What would it take for young people to recognize the fragility of their perceived immortality? What would it take for middle-aged people to put down the fork, the burger wrapper, the cigarettes, the poison in which we have all indulged in one form or another? What would it take for us to be our own cheerleaders? To encourage ourselves that no matter what the cost or temporary inconvenience, we have the responsibility of assisting nature to preserve our lives?

"I'm gonna die from something."
"It's too late for me. I've made too many mistakes."
"Baby, I'm just trynna make it."

Conversations of people on the brink of losing all hope serve as a sad motivation. A melancholic symphony of life pushing those who care to reflect forward and keeping them from giving up the battle. Life is beautiful. Even during our hardest moments it provides a hidden beauty only to be seen by the eyes of the most talented survivor. The one who hears the music and keeps building and rebuilding his or her own fortress. That internal fortress against all odds. The defense against the small holes in a raft to not only stay afloat but to navigate the vast and rushing rivers we encounter through this journey we call life.

My short time on this earth has brought many sad pauses and obstacles but a distinct type of hope. The kind of hope in humanity that despite all odds we have the capacity to come together and help one another through our individual and collective struggle. The kind of hope that I could not possibly create on my own but was blessed with by God. The hope that makes me recognize that despite our differences we have the intimate similarity of our human nature that connects us on a deeper level than we know. Unfortunately it is usually a tragedy that brings us together in the deepest sense. But since we have this capacity, there is no reason to await a tragedy to become the heroes and helpers to our brothers and sisters the way we know we can be. There is no reason to delay doing a good deed for someone. There is no reason to delay telling someone you love just the way you feel. Why should we wait until tragedy to open our hearts and minds?

The reality is we shouldn't. Because this life is precious and we are not guaranteed the safety of having a second chance, we have to take this moment. We have to make the right choice for the rites that our minds, bodies, and souls hold over us. We have to choose to be healthy. We have to choose to be happy and positive. We have to choose to encounter a struggle and make our mind set on creating a unique opportunity to succeed again and again. The reality is we don't have all month, week, or year to contemplate making a positive change. Only we can take the steps to embrace our God-given potential and bring it to fruition. We can't afford to delay becoming the person we want to be. We don't have time to hesitate to be great. We only have right now. Will we make mistakes? Sure. But it's up to us to keep on moving. We have to put on our life vests, grab a paddle, and hop in that raft. Who else can do that for us?
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The compressions were just as strong as 15 minutes before when they first began. You would think this man had just come into the hospital and coded on site instead of being found and brought in some time ago. I wondered if he knew. Were there warning signs? Did he have a chance to call out for help? What was the cause of his cardiac arrest? I would not get answers to any of these questions. Truthfully, I was too cautious to even ask. I saw the frustration on the faces of the attending and the residents. I'm sure a pesky action-seeking "shadow" is the last thing they wanted to deal with. 

"Ok, let's do another pulse check. How long has it been? Ok, we got to call it guys. Time of death 11:35pm."

The staff wiped their sweaty brows and retreated the bagging and compression efforts. After a brief discussion with Dr. A and some time to begin digesting the situation, I found the Intern Chaplain in the hall and decided to introduce myself. This was the first time he had to console a grieving family. I was relieved to know that this man had family. This man who had endured such suffering, whom I had intruded upon during his struggle for life, this man was not alone, he was a husband. His wife stood just across the hall from us handling paperwork with hospital staff.

The recently widowed woman stood dignified and calm. Sadness was in her eyes but her strength prevented any tears from falling in that moment. I wanted to say something to her. Hug her. Do anything. I couldn't shake the feeling of being of no help at all. After my brief discussion with the chaplain I turned to resume my shadowing experiences for the night. I said a silent prayer for the widow I could not console and her family as I walked away slowly.

As I rounded the corner I heard the screaming of a man who had just attempted suicide. The screaming, handcuffed, man had taken a handful of Seroquel while in police custody. He had been at the hospital earlier in the day with suicidal ideation. His room was two doors down from where the husband had just passed.  

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