Let it Rain

It’s raining today. A dark, heavy, steady rain – the kind that almost makes a wall. I was standing at a window in the hospital just now, and looking up it was like I was standing at the base of a great wall, one that extended from the hospital tower to the heavens. Only it was a wall of water, or rather, a wall of tears. Looking out, it was like I was staring at a wall of tears.

On Palm Sunday we sang one of my favorite hymns, “A Stable Lamp is Lighted.” It’s one of my favorites for so many reasons…I first heard it at the Christmas Eve service in my parish church when I was in third grade. I had a small solo that year, and I was incredibly excited. And I sang it well, to be honest. But later in the service – and unbeknownst to me – a slightly older girl sang “A Stable Lamp is Lighted.” She knocked it out of the park; it my have been the first time I experienced the raw power of music.

All these years later, in a different parish church, we sing this hymn on Christmas Eve and then again during the Easter season. Again I re-experience the raw power of it all, as I am forced to connect Christmas and Easter in a way that we are seldom asked to do. And even as I fight back my own tears, I sing:

And every stone shall cry
For thorny hearts of men
God’s blood upon the spearhead
God’s love refused again

And every stone shall cry! I see another wall of tears – a transparent wall between me and Christ crucified. A wall of water, but not one that is falling but rather one that is rising up, out from the crying stones on the ground.

On Palm Sunday we heard a sermon from an old friend of mine who loves to start things off with a story. This time around he recounted a Civil War tale. On a bloody battlefield in Georgia, a young Confederate soldier refused to kill. Amidst a torrent of bullets and knives and all manner of chaos, he stood there firing his gun skyward, unloading every last round into the heavens, refusing to shoot another man. He was exposed, defenseless, totally vulnerable…willing to take whatever came his way while refusing to do the one thing – killing – that might actually preserve his own life. And even now I see yet another wall – a rainy wall of bullets falling around that brave soldier. I picture him almost dancing as he empties his rounds – dancing to that haunting tune “A Stable Lamp is Lighted.” And every stone shall cry! The rain of bullets nearly forms a halo around him.

Sometimes I feel like that soldier – or maybe I just want to. With chaos and death and injury and hurt and sadness all around me, what choice do I have but to feel like I am simply firing my gun skyward and accepting whatever blows come my way? Or rather, what choice do I have but to fire my gun skyward?

There is something empowering, however, to think of myself as firing a gun into the air, and to say to the world that I can take the consequences. I’ll only go so far – I won’t kill – and I’ll take whatever comes from that. It’s very close to feeling totally defeated, but it is very different.

The rain has stopped, and the sun now shines. The buds of spring are all around – newness is thrust upon us.

Alleluia! He is Risen!

Working on major holidays always makes for an interesting night. I’ve only actually ever worked on one Christmas Eve – and I’ll never forget it – but yesterday evening/this morning was the first Easter I had ever worked. I kept my fingers crossed.

Of course, on this day of new life and rebirth, the horrible tragedies just kept rolling in. A horrific set of injuries in a car accident; a husband whose wife had stabbed him in the neck and whom we have to take the OR; a young man shot through his car windshield into his arms, face, and back; a young women found floating in a creek near her wrecked car.

My God, my God – why have you forsaken us?

I forced myself to get a bite to eat before leaving this morning. The cafeteria was basically empty, and the options were slim. But I settled for a yogurt, juice, and a corn muffin.

It’s hard not to think of family on Easter Sunday, and as I ate that silly muffin my thoughts drifted to my grandfather. He attested that the Revolutionary War was won, in no small part, because of corn. Fresh, New Jersey corn on the cob, to be exact. According to him, the bloody Lobster Backs were so entranced by the fresh corn that they couldn’t help but to just keep eating it – and all the while with the Yankees shooting away, winning the war, one ear at a time!

And while telling that story always makes me smile, it somehow saddened me to tell it only to myself, with no one else around to hear. Still fresh in the wake of the destruction that was the night before, I felt lonely, even further from the message of Easter.

My prayer this Easter – for me and for you – is to feel the warmth of the love of the risen Christ. He is with us in the car accidents; he is with us during the shootings and the stabbings, no matter which side of things we find ourselves on. And he is with us during somber moments of reflection. May we never feel alone – because we are not.

Happy Easter!

Thirst

There are many uncomfortable things about being a surgical patient. We put big IVs, and tubes, and drains into nearly orifice of your body as we try to get you better – the term “violation” comes to mind. But really what we’re doing is attempting to put your body in a position to best heal itself while we just provide the support.

One of the things that patients complain most about, interestingly enough, is when we don’t allow them to eat or drink. Nil per os – or NPO – is the designation for nearly every surgical patient who has an active issue. Part of this is to allow the GI track to rest, which sometimes is enough for recovery. Other times this is needed in anticipation of surgery. When a patient undergoes induction of anesthesia, the risk of aspiration – or regurgitation followed by choking – is greatly reduced if the stomach is completely empty.

It’s always been interesting to me that patients complain about being NPO at least as much, if not more, than anything else. We literally have patients who are recovering from gun-shot wounds to their bowels, or who are fighting life-threatening pancreatitis, or who are going to the OR imminently for repair of their pelvis which was fractured during that horrible car accident just a couple hours ago, and all they want is a simple drink of water. That’s it. They are experience excruciating pain and discomfort, not to mention emotional turmoil – and all they want is some water. And the answer is no; the risk of complications with anesthesia is just too great, and too unnecessary to take.

One of our attending surgeons recently made an interesting observation. On the trauma service here, we are forced to deal with a fair amount of death, and therefore a lot of end-of-life issues with patients and families. He observed that in conscious patients who are nearing death – and for whom we are providing comfort measures to – one of the last things they will do is ask for something to drink.

Yesterday was Good Friday, the celebration of the remembrance of Christ’s crucifixion. Because of certain circumstances, I was scrambling to find a church to go to, and my best option was a Catholic parish just a couple of blocks away. I’d been told before – by someone who, like me, loves the Episcopal tradition but who, unlike me, had Catholic roots – that while the Episcopal faith was beautiful, the Catholics just always seemed to get Good Friday right. I half smiled as I wondered where she would be going to church that afternoon.

The Mass was indeed lovely. And as it happened they read the Passion from the Gospel of John. Some scholars will remark that the big breakthrough in Biblical studies came with the understanding that the four Gospels were not necessarily four different historical accounts, but rather four different works of historical literature, written with different biases and for different purposes.

The Gospel of John is unique in that it explicitly has Jesus, while hanging on the cross and just before he dies, looking out and saying “I thirst.” He is given a quick drink, and then exclaims “It is finished.”

And now we wait.

Dreams, Part II (or Heartburn)

I haven’t been sleeping well lately. Again. Maybe it’s because work has been especially demanding these past few days. And it’s in the throws of those sleepless nights that my dreams become so vivid.

The other night I dreamed I was a trauma victim. I saw myself there, on the gurney, with tubes and lines and monitors all hooked up to me. I wasn’t in any pain, but I was fully aware of my predicament. In the dream, a couple of members from the trauma walked up to me to check things over, like we do on every trauma patient, several times a day. But they were unusually hesitant. I looked up at them and uttered “it’s different when you know the person, isn’t it?” They were silent, and tried to go about their business. Just then the situation changed. Alarms sounded. My pulse shot up, and my blood pressure dropped – I was struggling to breath now. Somehow I knew – like can only happen in a dream – that I was having a tension pneumothorax. This is when air escape the lung but stays inside the chest. The air expands, and pushes your lung and heart to the other side of your chest. It can be rapidly fatal, as it collapses your arteries and veins and allows for no forward blood flow. The only solution is to decompress the chest with a needle, and to release that air. My friends stood motionless as I thrashed on my bed and somehow found a large, 14 gauge needle. I unsheathed it, and held the tip of it right between my second and third rib spaces on my left – just above my heart. I took one frantic look at my friends who nodded their approval. With only a tad of reluctance, I stabbed myself.

And then the pager went off. I was awake. I clutched my breast to make sure there wasn’t anything sticking out of it.

The page was alerting me to a new trauma. A guy ran a red-light and then attempted to avoid being pulled over from a police car and had managed to flip his vehicle in the chase. He had suffered some obvious orthopedic injuries to his lower extremities. Likewise his passenger suffered injuries to her legs. What became apparent, though, through some questioning, was that this gentleman ran from the cops because he didn’t want his wife to find out that his passenger was actually his new girlfriend. The plan didn’t work out too well, though, because while he was lying there in the trauma bay his wife was notified and she immediately came in. And so she saw the both there – her husband and his girlfriend – lying side-by-side in the trauma bay. With their matching lower extremity injuries and all.

Running away – it just always has a way of making things worse.

I finished my work and pulled myself back to the call room and hoped to get another hour or two of sleep. But just as I shut off the light and put my head down I felt something very unusual for me – heartburn. Massive, burning, nearly incapacitating pain like I have never felt before. I was literally writhing in pain. I imagine the pain was located somewhere between where I was going to stab myself and where our new patient’s wife was feeling her own hurt.

I searched high and low, but there were no antacids to be found. I settled for some crackers and milk. What could have been a nice two-hour sleep turned into a thirty minute nap.

I hope I don’t dream again tonight.

Dreams

The Stanley Cup Playoffs have finally begun, and while the Flyers have been a tad disappointing lately, I always rest my hope in their fate and blindly cheer them on. I like to tell myself that the pit I feel in my stomach these days is not at all something deeply personal but rather my nearly visceral concern over their goaltending situation.

I’ve had a recurring dream lately, which is odd because I seldom used to remember my dreams. I’m playing hockey in this one. I’m effortlessly carrying the puck through the neutral zone, nearly dancing as I glide over the ice. My head is up, I’m stick-handling well…I’m doing nearly everything right. Just then a new player appears, behind and to my left, and so out of my view. His stick is raised, and it comes down and chops at my feet. I never saw it coming. My skates are forced into each other, and I am thrown through the air. I crash onto the hard ice and slam into the boards, where I curl up and remain motionless. Suddenly it is all darkness. And then I feel a hand on my shoulder. A soft, gentle, sweet hand, whose every contour I know and love. It…feels…so…wonderful.

And then I wake up. I guess it’s more of a nightmare, really, or at the best a cruel joke.

Today is Palm Sunday. The Mass, no doubt, will be beautiful and moving. The triumphant start to Holy Week. We all know what’s coming.

On the Brink

Las Vegas is quite the place. A bit overwhelming, to say the least – it’s the place where you see quiet couples clutching each other’s hands to make sure neither gets lost in the crowds and chaos.

It’s definitely a town of consumption. Food, drink, sex, gambling…you know the list as well as I. And it’s all there for the taking. Of course, with some of us, the concept of taking doesn’t set very well. You shouldn’t take what’s not yours – we teach that lesson in preschool because it’s that’s important.

For the last couple of hours of my time there, I found a quiet ledge overlooking the fountains at the Bellagio resort. These are big, spectacular ones from all the movies – I loved them. In the dead center of Sin City, I found myself alone, and in quietness. I wore sunglasses so nobody could see my eyes. One year ago I spent time overlooking a very different body of water, under very different circumstances. I was not alone then.

A few days earlier I had actually been doing pretty well. I was laughing, making sarcastic comments, energetically going about my work – maybe it was the right combination of sleep, breakfast, and company. Who knows. But I actually caught myself – you’re not supposed to be this happy, I said. Stop it. Remember? And looking at the fountains I found myself angrily saying – you’re not supposed to be this sad. You’re in Vegas! Remember? I get to the brink of happiness and I bring myself down. I get to the brink of throwing myself into that water and I somehow pull myself up. Up and down I go until I’m exhausted.

Right on cue the fountains came alive and started dancing. “Time to Say Goodbye” echoed over Vegas, and the fountains put on a show that nearly put tears to my eyes – yet another good reason for the sunglasses. Of course, the song isn’t a gentle, inspiring bit of empowerment that we might think it to be. It’s more a testimony that the world forever changes once you find love. Indeed. And once that love is lost – or taken – the world changes again. Thanks for the reminder.

I am glad to be out of Vegas. There's only so many ups and downs I can handle.

Ora Labora

One year ago. It was the happiest weekend of my life. There were families, friends, flowers, music, rings, and promises. There was joy and excitement. There was a dress, suites and ties. There was nervousness, and yet there was peace. There were memories of the past fueling hopes for the future. It all felt so real.

And of course, there was love.

Now what? What’s left? From the list above, not much.

How could things have changed so profoundly in a year’s time?

Come, labor on. Who dares stand idle? Not I! Not I!

So for now I'll stop crying and start standing up straight again - and try to become whatever it is I'm supposed to be.

Goalies are Crazy

I’ve spent a significant amount of time standing between goal posts attempting to keep small, hard, rubber objects from getting past me. Whether on the cool ice of a hockey rink or the worn grass of a lacrosse field, I just – for whatever reason – always felt comfortable in the goal.

Everyone knows that goalies are crazy. I mean, who in his right mind would willingly choose to block pucks and balls with his body? Most kids dreamed of scoring that winning goal; I dreamed of preventing it.

In my earliest days of playing hockey it was all I could do to stand on my skates without falling over. I have a video of my first game. Everyone is in position for the opening faceoff, but they all had to wait as I slowly made my way from the bench to the goal, falling several times along the way. In those early years when I was scored upon – which happened quite regularly – coaches and parents and teammates would all come up and express words of encouragement. And this mostly consisted of them saying “it’s not your fault.” When I was six, that was helpful to hear.

As I grew older I allowed far fewer goals. And it became increasingly clear to me that, as a matter of fact, it was entirely my fault when a goal was scored. Whose fault could it be? Goaltending is very difficult, but it’s also insanely simple: keep the puck out of the net. That’s it.

And that’s a pretty hard line to take on your own performance. But I did it, every day, and still came back for more. Goals would score, I’d blame myself, and inevitably more goals would come. I’d have good days and some bad ones too, all the while trying to give off the impression of an even-keeled goaltender. I loved it. Maybe that’s why goalies are crazy.

But the real crux of the matter isn’t the degree to which I blamed myself. The real test came after the goal was scored and the teams were lining up for the next faceoff. What then? How would I react? The goal had already scored, the right light had flashed, and the crowd was still excited…but what will you do now? Because another shot is coming. At least I know that much.

Scarred

Last week a young man came into the surgery clinic complaining of severe abdominal pain. His pain was crushingly bad. He had been nauseous and was vomiting, and his belly pain would come and go with the sharpness of a knife. It actually reminded him of the time he got stabbed last summer.

At that time he came into us as a trauma victim. The knife had passed through his abdominal wall and torn a hole in his small intestine. He was taken immediately to the OR, where that segment of bowel was resected and the remaining portions reconnected. He would walk out of the hospital with a rather long scan down his belly, but other than that he was good as new.

Except that, as I tried to explain to him, his body hadn’t forgotten that little incident. The scar he still sees on his abdomen – although it’s somewhat faded – was the result of us cutting his skin. But the same scarring process was going on inside him. The area where his attackers knife passed and where our scalpels would follow was an inflamed, wounded mess, and his body was trying to scar it out. Unfortunately this is not without consequence. The scars form long bands – called adhesions – ad they can wrap around your intestines, causing life-threatening intestinal obstruction. Can you imagine? A healing process gone horribly wrong.

The next time you see me, look closely at my face, and see if you can see the scar from the scalpel. It will have faded by then – hopefully – but realize that it’s really nothing more than a representation for the scarring that is ongoing within me. And even as the outward version is improving, it’s impossible to tell what’s really going on inside. Perhaps it’s nothing. Then again, perhaps one day I’ll be so buckled over in pain that I’ll need surgery. Here’s hoping.

Cavitation

The other night a man was brought into the trauma bay. He had been shot in the back, just inside his left wing-bone, and the bullet had traveled through his chest and exited just to the left of his sternum. “Through and through,” as we say. It never ceases to amaze me how small the wounds look on the skin. They so small, in fact, that they often fool us into thinking that they are not serious. A large chest tube was placed into his thorax, and two liters of blood rushed out. It was off to the OR.

With the help of a cardiac surgeon, we sawed through his sternum and exposed his heart. It actually looked pretty good – essentially injury free. We looked next at his left hilum, which is the beginning of his left lung and the confluence of arteries and veins there. It was a pulverized mass of destruction, hardly recognizable, with blood pouring out of a gigantic hole. He was dead, even as we identified the fatal blow.

When a bullet travels through someone it makes a track – a simple line of damage along the path of the missile. But it does something else as well. The kinetic energy of the bullet causes a cone-shaped area of destruction which is wider than the simple path. This is called cavitation.

The analogy that is often used is that of the wake of a boat. When a boat travels through the water – let’s just imagine for a moment that it’s off the coast of Maine in happier times – it obviously disturbs the water along its path. But the wake reminds us that the disruption extends much further than we might have imagined.

Personal relationships are the same way. I don’t know if it’s possible to have a serious relationship without cavitation – without that energy reaching far wider and wounding much deeper than imagined. The wounds on the surface may look deceptively small, but inside – right next to the heart – they cause massive, and potentially fatal, hemorrhage.