Going Places

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“Ok, I’m going to call it. Any objections?” 

Silence from the room. 

All motion stopped. No more CPR. No more rummaging for the next medication in the crash cart. The nurse on the phone calling for another two units of pack red blood cells simply stopped mid sentence and hung up.

I dropped the empty syringe that had spent the past hour and a half clutched in my right hand into the pocket of my white coat. The fingers were stiff and achy as I stretched them out. “Time of death….” I cranned my neck around the greying head of the house supervisor so that I could see the wall clock by the door. “…. 0325.”

“Good job, everyone. Let’s clean up so we can let the family back.”

Syringes were counted and recorded by the clerk to make sure the amount of each med given was accurately reflected in the log. Debris was swept up. Hands gently covered the emaciated body with a gown and pulled up the sheet, the eyelids were closed. A nurse took out the IV and another pulled the tubes from his nose and mouth, wiping the blood and mucous from the now lifeless lips. 

He looked so peaceful.

Cancer of the stomach. He had certainly suffered. He was not willing to die peacefully, refusing hospice and refusing to sign a “do not resuscitate” order. He fought even at the end. 

My wrist still hurt. 

I liked being around death. It was hard to explain to people. They would stare at me with a puzzled and slightly horrified look on their faces, lost for words so I stopped talking about it altogether. I always wanted to ask the dying to put in a good word for me when they got to where they were going, but I never did.

One by one everyone left the room.

In a minute I would go out to his wife and children and explain that we had done everything we possibly could but I needed a minute before facing the onslaught of grief.

I put a hand on his chest and said a silent prayer for his soul, then one for mine. I looked back up at his face. Strangely, his eyes were open. They were a bright blue. The bluest blue I think I had ever seen.

Then they blinked.

A hand grabbed my shoulder and pulled me closer. 

His hand. 

My heart skipped a beat as fear rushed through my body and into my fingers and toes. 

Then the hand let go and fell back to the bed with a flop, as if there was no more energy left. It must have been some sort of cadaveric spasm…

“She knows.” 

The rasping sound came from his lips but how could that be? He was still attached to the heart monitor, someone had forgotten that detail, and there was no heartbeat. I checked for a carotid pulse. Nothing. No breathing.

“What do you mean? Who is she?”

The eyes bore into me. 

His lips moved. “She knows…” I touched the lips. They were cold.

“Who is she?!?!??” I asked again.

No response.

My voice rose as I asked again and again but the blue eyes just stared back at me never wavering. I grabbed the shoulders and shook him but he still provided no answers.

Anger and terror rose up into my throat, swelling into a tight lump that lodged there. My brain raced from irrational thought to irrational thought. I could not breathe. 

Someone knew what I was doing? But how? I’d been so careful!

My hand touched the pocket with the empty syringe.

Rage. 

I grabbed his shoulders and shook him. Hard. I punched the chest. I yelled at the blue eyes, tore at his lips…

Someone pulled me away.

“Doc! What the hell is wrong with you?”

“She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows….”

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New Outlook

Lookout at Rockefeller Center in NYC

The beeps. 

I know those beeps.

From where? 

I don’t have the energy to find out. My head hurts something fierce. I slip away, choosing to remain in the darkness for now.

*****************************************

The pain at my sternum is excruciating. 

Make it stop!

Except that I don’t have a voice. There is a tube down my throat and I cannot speak. I try to grab the hand at my chest by my arms do not respond.

“Dr. Slaughter? Wake up. Can you hear me?” The voice is much too loud and the words are spoken slowly as if the man enunciating them were speaking to an imbecile.

The pain stops. Then I realize…

A sternal rub!

My eyes are open. He moves his face close enough to mine that I can smell his aftershave. 

“Dr. Slaughter? My name is Dr. Holcomb.” He was too young to be a doctor. Too young to be competent. “Wake up!” he shouts into my ear. 

The pain again. Stop with the damn sternal rubs you f***er! I AM awake.

*****************************************

“The patient is a 45 year old male who happens to be a local physician. A neurologist. He suffered a brain stem hemorrhage two weeks ago and is currently in a persistent vegetative state. He has no family we have been able to locate.”

*****************************************

I take inventory. What can I move? Arms? No. Legs? No. I try to tense my abdominal muscles. Nothing. A shift or a scoot to take pressure off of my hips. Not even a millimeter. Smile? No. Wrinkle the nose? No. Tongue? Not that either. Blink? Ok. Yes. A blink. I try to move my eyes. Left. No. Right. No. Up? Yes. Down? Yes. 

Not much to work with but it’s something.

*****************************************

My dog! Who is feeding my dog?

He was probably dead by now.

*****************************************

“Well, his catheter caught on the IV pole so when they were wheeling him down for the MRI, it got rippped right out. We have to place a new one.”

“Should we use the lidocaine jelly?”

“Nah. He can’t feel anything anyway.”

I felt it, bitch. I felt that catheter rip right through my urethra. Use the goddamn lidocaine jelly. Come on. Look at my EYES. See me moving them? Blinking? 

Please? Just LOOK at me. Really look look at me. Someone?

I can make tears.

The night nurses here suck. 
*****************************************

The woman is smiling at me. 

Who is she?

She’s gorgeous. Dark hair. Blue eyes. Long lashes. I have this strange feeling. I think I should know her. 

“Remember me?” She whispers. 

No. No, I don’t.

“I was the intern you came on to ten years ago. A newbie. You told me to go get some gauze and then followed me into the supply room, locking the door and forcing yourself on me. I made it seem I was flattered.” She fixed her gaze onto my eyes and leaned in closer. “But I wasn’t.” 

Her hand was under the sheet, stroking my genitals. An erection. Horror and pleasure washed over me.

Oh, God.

The heart monitor registered the increase in heart rate. A nurse stuck her head in. The hand was withdrawn.

“Oh! Dr. Rutherford. I didn’t realize you were in here.” 

“Dr. Holcomb asked me to see the patient.”

The nurse nodded then stepped out, drawing the curtain closed behind her.

“I hate you.”

Suddenly, fingers wrapped themselves around my scrotum and squeezed tight. Painfully tight. I closed my eyes, fighting the excruciating pain.

“You have locked in syndrome, don’t you, Dr. Slaughter?” She laughed. “You can feel everything but you cannot move. Well….” she chuckled again. “You can move your eyeballs up and down and blink but they haven’t figured that out yet, have they? You taught me well about so many things…”

Another squeeze. More pain.

“You probably know better than anyone that you likely won’t recover.” She smiles sweetly. “But I’ll be back to check on you. Every single day…”

Lift

Bomber

There are times when the anxiety overwhelms. Pressure on my chest. Can’t breathe. A dysphoric and irrational sense of impending doom falls like a curtain, separating me from the rest of the world.

I need to move, to escape. 

But I can’t. 

Why? Why now?

It comes in phases. There are times when I fly through the day, a smile inside and out. I feel the joy. I am the joy.

And then? The darkness descends.

You aren’t good enough or smart enough. Someone is going to figure it out. Then everyone will know your secret. You don’t belong here.

I can’t focus. I type words that aren’t right and don’t make any sense. I cannot follow the conversations people try to have with me. My brain is paralyzed. No. My brain is in overdrive running from one imagined catastrophe to the next. I cannot sleep because I cannot make it stop.

“Doc, it’s like you know me. How do you understand it so well when I am not even sure how to describe everything?”

Because I am you.

Sometimes there is good reason for it, an event which serves as trigger. Like a supoena to testify in a patient’s lawsuit against an multi billion dollar international corporation. Sometimes there are dozens of good reasons for it. Being on call, stressful patients, behavior issues at school with my kids, extended family conflict, pressure from the suits, my virtual desktop at work is overflowing, the WordPress app reader is frizzing out again and I am missing posts, … Very often, though, there is no good reason at all.

It is then that the pill calls to me.

Die to live another day…

I keep a bottle with my name on it. Not to literally kill myself. Just to make life easier. Kill the anxiety. End the suffering. A pill a day to make the anxiety go away.

But I am a coward it turns out. I am not good at taking pills. I try to do other things. I take a hike in the woods. Being among the trees often helps. Instead, I get a bad case of poison ivy. I try attending an opera, but I can’t enjoy that because of the itching from the poison ivy. I buy a new skirt but it doesn’t fit because of the steroids for the poison ivy. I want to hug my kids…. hugs from my kids often helps… but good squeezes set off the itching again.

All I can do is laugh. There is nothing else left to do.

Suddenly I am rising up out of the abyss. 

Friday the 13th

Ellis Island building detail

Every Friday the 13th I tell myself I am NOT going to work. I am so over the bad luck. 

Is it really that much worse than other days? Are people sicker? Is it maybe that everyone is walking around irritable and more afraid than usual and it boils over into how they interact with others? Am I just hypersensitive? Is it a self fulfilling prophecy? 

I dunno. 

All I know is that I don’t want to do it anymore.

Then it sneaks up on me. Every single dang time.

BAM! 

There is nothing to do but just get through it. Buckle down and get it done. 

Survive. 

And we do. 

We always do.

This Friday the 13th it was different, though.

“She looks yellow…” the medical assistant whispered as I pulled up the chart. 

I scanned her info. I’d never seen her before. Hypertension. Diabetes. Cholesterol. Nothing else remarkable.

Knocking authoritatively on the exam room door, I entered.

“Hi! I’m Dr. Denisof. Tell me what’s been going on?” I shook her hand, taking in her appearance. She was quite jaundiced. 

“I don’t know. I woke up this morning and pretty much freaked out when I looked in the mirror.”

“Any other symptoms?”

She shook her head. “Nothing.”

“No fevers? Abdominal pain? Nausea? Diarrhea?” She shook head no each time. 

“Hmmmmm.”

I started examining, working my way from her head down. Eyes, ears, nose, throat all fine. Lungs clear. Heart regular rate and rhythm, no murmurs. 

“Let’s have you lie down.”

She complied.

Her abdomen sounded normal. I pulled off the stethoscope and palpated her abdomen. No masses. Liver felt maybe a bit enlarged. No pain. 

I helped her sit up.

A strange look came over her face and she doubled over, gagging. Blood poured out of her mouth and into her hands, dripping onto her lap.

“Call the ambulance!” I yelled out the door then grabbed an emesis bag, thrusting it under her mouth. She gasped and the vomit stopped for a moment before another retch wracked her body, bringing up more. The room filled with the scent of rust and iron. 

“Need help?” An MA stuck her head in:

“You called 911?”

“Yes ma’am.”

“Can you print a chart summary and her last set of labs for the EMS?”

“Sure thing!”

“And let the other patients know I am going to be running late while we deal with an emergency.”

“No problem.” 

Sirens were audible in the background, growing louder. Having a clinic so near the fire station definitely had its benefits.

Another retch, more blood. 

I put my hand on the patient’s back and looked into her frightened eyes. “You are going to be OK.” She nodded but did not look convinced.

My mind was running through the differential diagnosis. Causes of rapid liver failure, fulminant hepatitis…. infection? Some sort of aggressive cancer? Drugs? A closet alcoholic? 

The sound of a stretcher came from outside the door and two hunky firefighters in dark blue uniforms stepped in. 

“What do we have here?” the tall one asked.

I gave the run down of what I knew, pointing at the bloody emesis bag. 

As I spoke four sets of eyes grew bigger and the firefighters suddenly backed out of the room. 

What the hell?

“Hang on, I’ll be right back,” I told the patient. I left the door cracked so I could hear any more vomiting or any sounds of distress.

One of the men muttered into a radio receiver on his shoulder. The other took a step toward me, his hands raised.

“Doc, we need for you to step back into the room.”

“Why? What’s going on.”

“You are quarantined.”

What?” More sirens. Through the windows I could see police cars racing into the parking lot, surrounding the building.

“Look, no one can leave this clinic. No one. The CDC will be here shortly and they’ll explain everything.”

*****************************************

The above was a bit of fictional doctor horror brought to you by the month of October…

Flight

Birds in flight inside the American Museum of Natural History in NYC

“I asked her, ‘Aren’t you afraid?’ She touched my face and smiled. ‘No. Not at all.’

‘How can you not have fear?’

‘Because I have you. You are the strongest man I know.’”

He stopped for a moment, emotion stealing his words.

“The tumor doubled in size in 7 days. I don’t know what to do, how to help her… how to let her go.”

I have had so many conversations like this, two just this week. I always marvel at how the afflicted can be so strong, so full of peace and resolve even as those around them are falling to pieces. 

What sets them apart? 

There have been times in my life where I have been so depressed I have prayed to die. 

Please, God, take me in any way that you see fit…

But I was never peaceful about it.

I have fear. So much fear.

Fear of suffering. Fear of the unknown. Fear of the loss of control. Fear of being known for who I really am.

Who am I?

What sets them apart?

How do you come to terms with dying? 

“She says she will see me later, that it isn’t really goodbye.”

Faith.

Is it possible that it is simply faith in love… love which takes many forms… that gives us peace?

The Overseers

Through a window at the American Museum of Natural History in NYC

I see your drones flying overhead,
Your truck driving by.
I know you are watching me,
Following my every move… 
Silently waiting 
For the proper time to strike. 
You know my internet searches,
The names of my kids. 
You know my habits 
And my darkest faults. 
Some days you know my secret wishes 
Before I can even get the chance 
To wish them. 
Always there, behind the scenes 
Your satellites measuring my level 
Of devotion. 
Well placed hints, strategic glimpses, 
All forms of intimidation
Meant to remind me that I am yours 
Entirely,
Forever subject
To your every whim.

*****************************************

If you want to see something fun, zoom in on the bottom left of the photo.

The Twelfth 

World Trade Center

“Mommy, why are there so many police everywhere?”

I looked around. She was right. They stood on every street corner it seemed, decked out in bulky bullet proof vests. New York City, more than any other city in the world that I have visited, possesses a very visible police force. No longer simply protecting us from each other, they stood ready to protect us from them.

Did it make me feel safer? 

Yes. Yes it did.

I grabbed my daughter’s hand as we crossed the street with the crowd of other people. The Empire State Building rose up in the distance. 

“Are you going to take your kids to the 9/11 museum?”

They are six and seven.

“No. They aren’t ready for that yet.”

I’m not ready for that yet.

I dropped my purse and camera into a bin and wiggled out of my jacket, sending it and my ball cap through the scanner then stepped through the metal detector. The security guard nodded silently. We were free to move on to the next staging area. 

“Mom, why is it that everywhere we go here is like the airport?” my son asked.

In truth this was the forth scanner we had walked through on this trip. Long lines made longer by strict security. Stress. My kids felt it. So did I.

“Some years ago there was an attack on two tall buildings here in New York. They collapsed and thousands of people died. There are people who hate Americans and want to hurt them so the police and all of the security measures are trying to prevent something from happening like that again.”

Watching the towers collapse over and over again on the news feed at the clinic between patients, the world shifted. It wasn’t until the next day, as the dust was settling, that it became apparent just how much it had shifted. 

My kids seemed to take in the information and I braced myself for more questions, for fear, or even tears from my daughter, but there was nothing. 

Nothing.

This is their world. They don’t know what it was like before 9/11, a world where simply being American carried with it a certain degree of power and respect. They didn’t feel that shift. They will only know a September 12th world, a world where they are targets. 

Split 

Room in the Metropolitan Museum of Art in NYC

Shadows watched from the corners of the room… ever present, ever vigilant. 

She waited.

Footsteps in the hallway. Raucous laughter. 

The door flung open and he stumbled in, drunk, clinging to the arm of a woman.

Who was it this time? 

It was hard to see clearly in the dim light. 

Her.

Their eyes met for a long moment. Silent words passing between them. Then she turned her attention back to him, allowing him to undress her. He fumbled. The process took much longer than it should have. 

Naked.

She glanced at the mirror again, seeing the other woman once more, the one who looked like her but was more charming, the one whose laughter came more easily. She was the one who was not ashamed of being naked, the one who demanded love and attention from everyone.

The drugs made her beautiful and charismatic. She knew the flame could not burn this high for very long. It would go out soon, extinguishing her in the process.

But it was worth it. 

Every day was worth the price to avoid the loneliness again.

Shopping Around

Macy's in New York City

“She doesn’t have physical exam coverage and her insurance only allows three office visits per year. No lab coverage. No preventive care coverage. She needs her blood pressure and diabetes meds refilled but she cannot come in for a physical.”

I’ve seen this a lot lately.

“No problem. Tell her to come in for a regular office visit so we can at least check her blood pressure. I will code a 99214 and she may get a 30% discount off that as a cash pay patient. I can send her to a discount laboratory for labs that will save her hundreds of dollars. In October she can get a $99 mammogram at one of the local imaging centers. Her flu vaccination she can get cheap at the health department. We will just have to postpone her PAP another year.”

So she came in….

Crying.

“I pay over $700 a month for this insurance.  I work for myself and with my diabetes no one will cover me otherwise. I can’t afford anything else. They told me that all of my doctors were covered and my meds were covered. They lied.”

She did not read the fine print. Not that she really had any other options available to her… 

It used to be like this ten years ago. People with expensive but essentially useless policies. Here we go again. Now, at least, I have access to a discount laboratory.