On Sleep

Growing up, the time right before I fell asleep was always my favorite time of day. After a hectic day, there was something magical about being still. You can’t rush falling asleep, and I never did – I would be alone with my thoughts until the new day’s challenges would come.

My favorite prayer – at least one of them – comes from the 1979 Book of Common Prayer. I remember it echoing around a nearly empty Cathedral on so many late afternoons, with only a boys’ choir and the stained glass to hear it. I suppose it sums up what I wished for in sleep

O Lord, support us all day long until the shadows lengthen and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then in thy mercy grant us a safe lodging, and a holy rest, and peace at the last (BCP 833).

My nights now are a little different. About every third night, while on-call in the hospital, a busy day makes one excited for a few hours rest. But sleeping right next to a pager – a pager that is sure to go off at any moment with something as trite as a Tylenol order to something as magnanimous as a gun shot wound to the chest – sort of ruins the tranquility of that time of day. Sleep is now rather anxious.

I often feel guilty at how I must look in the early hours of the night, recently awakened, seeing a new patient. Sometimes they apologize for waking me up, as if their illness is a mere inconvenience for me. I politely do what I have to do, and get back to resting if at all able. It’s amazing how focused one becomes on sleep. I am reminded of Psalm 121: “he who watches over you will not slumber; indeed, he who watches over Israel will neither slumber nor sleep” (3b-4).

One of my favorite stories of Borges is The Secret Miracle (http://fortunaty.net/com/textz/textz/borges_jorge_luis_the_secret_miracle.txt). An author is to be executed, but before he is sentenced to death he prays for one year’s time to complete his literary masterpiece. He is brought before a firing squad, but just before the bullets hits him time stops. His consciousness, however, remains, and he can finish his work in peace, in his mind. At the moment the final verse is complete, the bullets resume their course, and the author is killed.

What an amazing thing, to be in a state of productive, restful, sleep, and to die once it is complete? ML is an 86 year-old female. She had atrial fibrillation, multiple gastric ulcers, ischemic colitis…we repaired her stomach, removed her colon, put her back together as best we could. With our help, she lived for about two days. She looked like she was sleeping. She was just lying there, still, not doing anything. I don’t know what she was thinking. Last night, she died peacefully with her two sons at her side.

Make no mistake, I’m sleepy! And so off to bed.

Thinking Thoughts

One of my favorite things about living in Philadelphia is the Rodin Museum, the second largest collection in the world (behind only Paris) of the sculptor’s works. Outside the museum, in front of a beautiful stone gateway, sits a caste of The Thinker, Rodin’s best-known piece that depicts a man hunched over in deep thought.

There is a small but lovely garden between The Thinker and the entrance to the museum, a garden that is truly a wonderful place to sit and think. I’ve often found myself there on quiet afternoons, looking at the trees, peering at the fountain, and letting my thoughts wonder. What could The Thinker be thinking about for all these years? What was so important? Has he got it figured out already? I’ve just spent the last hour reading on hemodynamics and the oxygen carrying capacity of blood – do you think he thought about any of that? Or was there something more important, more pressing?

Eventually, in the garden, I find my eyes drifting towards the main entrance to the museum. It is adorned by Rodin’s largest – and final – project, The Gates of Hell. It is 6 meters high and contains 180 figures; it is meant to depict a scene from Dante; it is terrifying. It is the only sculpture I can imagine that somehow, despite its location in a dark entrance to a museum, can completely captivate the mind of someone who is trying to get some peace and quiet in a lovely garden in the middle of a city. It screams at you. It shrieks. You have to take notice. And sitting there, nearly at the top of it, amidst all the demons and souls, is a miniature The Thinker. And he’s still thinking.

I guess one of the scariest things about death is the eternal loss of consciousness. Of course, on one hand this is silly – you can’t be aware of a loss of consciousness, so how can there be anything to actually fear? Yet in another sense it is nauseatingly horrifying to imagine just how long eternity is. Some have written that hell might not be so bad, given the choice, since at least there is a presumed level of consciousness. And with consciousness comes hope. Of course, Dante thought of all this – his gate of hell carries the inscription “Abandon all hope, ye who enter here."

At the burn center – as in any ICU – we have a lot of patients who are on “life support.” That is to say, they are so sick that we are breathing for them (mechanical ventilation), feeding them (via percutaneous endoscopic gastrostomy tubes) and assisting their heart (with inotropic agents, vassopressors, or aortic balloon pumps). All of them are heavily sedated – they have to be, otherwise they will fight the ventilator and be in agonizing pain. I have no idea what their level of consciousness is. I do know that for some of them there is great hope of recovery, while for others there is practically none.

Just recently, The Thinker was temporarily moved to inside the Philadelphia Museum of Art, while some construction takes place at the Rodin Museum. There now sites just an empty pedicle where the statue usually sits. It’s like he finally figured it out, and quickly got up to do something. And so maybe it’s time to take a break from these eternal questions and just focus on living actions. To just do. It’s worth a try.