Life Support

I found myself in a field last night. I couldn't come home right away; to the lights and the noise. To the way life is so constant. I needed to feel small. I just drove. I drove away from the city, taking twists and turns until it felt right, and I dumped myself into a field. Flat on my back; staring up at the sky. It was cold and windy. I wanted to be close to the ground, to feel insignificant and not powerful.

I wanted to feel held by something bigger.

I let the ground caress my back and my hair; I felt the wind sting my cheeks and my hands and let the cold bleed through my thin scrubs. I felt shivery from the temperature, but I'm certain I could have slept in that field; peacefully. I stared up at the sky, all the millions of stars, and wondered at each of them. I let them diminish me. I let my energy drain into the ground and asked for something back. Please. Please give me something back.

And I wondered what it will be like to die.

I was shaking inside during rounds when I confronted Dr. L. But my outward demeanor and voice were both calm and kind. I was level-headed as I told him it was time to let go. "We cannot save him. We have to be mindful of resource utilization. Even if he is not suffering, we cannot continue this while we stand here and say out loud that we know it's futile. That isn't right. Everything we do costs money. To the system; to him. Part of our job is saying 'no'."

He argued with me. And I felt... rageful. He's optimistic. He always wants a "why". He wants to push until there is nothing else to offer. For every patient. I wanted to shake him and scream. And then I felt compassion for him. He's tired, too. Tired of everyone dying. Tired of working so hard and feeling like nothing we do ever saves anyone. Tired of going home to his family feeling like a failure; and not having any words to explain it.

I am tired. I am tired of being the one to say it. Tired of being the loud voice. Tired of the energy it takes to check my feelings and be level and calm and grounded; of being the voice that makes the interns stare at their shoes in awkward silence.

The voice that speaks what everyone else is thinking.

Hours passed. And finally, he heard me.

So, there I stood with D; with permission to end his life. I wished I hadn't said anything in rounds. If I'd just kept my mouth shut then I wouldn't be standing there; his last person. I don't know if I can do this again.

There I stood with this artificial power to end his physical life. I stood with my hand on his chest, feeling the ventilator cause its rise and fall. Feeling his heart thud under my hand from our medical support of his blood pressure. I felt it fade as I turned those medications down, slowly, hoping that if he could feel at all, it didn't startle him; the feeling of his heart stopping; the feeling of us taking away his breaths.

He never took any of his own breaths.
It took 2 minutes for his heart to stop.
That is why they call it life support.

I never took my hands from him. I stared at his face, wondering what it looked like when it was full of life. Wondering what his voice sounded like. Wondering if his eyes sparkled; if he was kind. Wondering what it must be like to experience this most intimate of things with a stranger. Wondering if perhaps his spirit left his body days ago, and I had my hands on a lifeless shell.
The chaplain showed up. I felt almost possessive. Get out of here with your stupid prayer. Don't cry your tears in here like you know him. Just get out. He is my patient. And don't look at me with that compassionate face. You don't know.

I zipped him into a bag, almost afraid that he might know he was inside. I checked his pupils one more time; pried open his dead eyes to make sure they didn't react to light. I put my hand once again on his chest, to reassure myself that his heart was indeed, no longer beating.

And then I went next door. To my young woman dying of metastatic pancreatic cancer. To her withered and cachectic body; gaunt and ravaged by a cruel and painful disease. I willed myself to lock the tears inside. Do not let them spill over. Not now.

I willed myself to smile sincerely. To care genuinely, kindly and patiently.
Because she needs me, too.

Do not judge the hardness. It's essential.
Do not assume there is only frustration and anger. It's not that simple.
I cannot simply “shake things off”. It doesn't work like that.

It feels impossible to have anything left to give at the end of those days.
And it feels impossible to be around anyone.

And I will go back. Because I am good at it.