Surfacing

There is a drowned boy in the unit.

He's from Tibet. He's a physics student.

We have this beautiful recreational center at the university--I mean--you've never seen anything like it. It's the most beautiful, uplifting, marvelous gym you can imagine. It has a climbing wall and lounge chairs and computers and lattes and great exercise equipment. It has three pools--an olympic size one with a diving tower, a meandering "water park" sort of pool indoors, and a pool outside. It has fake banyon trees, a teeth whitening salon and tanning beds. All paid for with state tax dollars! (and then we can't get the new cancer center built, or a new nursing school--but that's a different story). So the drowned boy came from freezing Tibet, got into the physics doctoral program here in sunny Little Dixie, and, enticed by our beautiful swimming facility, decided to take swimming lessons--something not routinely offered in Tibetan mountain villages.

He lived in a local apartment complex with a lot of other foreign students, mostly Chinese, and he did something not too terribly crazy. One evening, he and another girl who had also been taking swimming lessons, decided to swim in the pool.

Only he hadn't yet progressed to the deep end, but he decided, since he was with the girl, and he knew in principle how to swim, that he would go ahead and try it.

Then he panicked. And sank. In 8 feet of water.

His friend couldn't get him up. She ran from door to door, rousing the other students. She collected 30 people, but no one could swim! Someone called 911. The paramedics pulled him out, but he'd been under for 10 minutes.

I drowned once, when I was 3. I did the same thing this boy did. I thought I could swim and I went into the deep end. I remember staying afloat for a little bit, feeling proud, but then, somehow the water became bigger--and staying on top of it became harder and harder. I don't remember panicking, in fact, I remember being far below and looking at the sun coming through the blue water and thinking, "I'll get back up," and paddling harder. I was right near the smooth white wall of the pool and I tried grabbing on to that, but I couldn't get a grip. And I remember the bottom of the pool and breathing water in.

I guess what happened after that was that my mother jumped in (she'd been writing a letter and hadn't noticed me go down), pulled me out and gave me CPR. I revived right away. I don't think I even went to the doctor. I remember staying in bed a few days. But you know, come to think of it--I had pneumonia all through my childhood--almost once a year. So maybe it damaged my lungs. I never made the connection until just this moment--but of course, that's probably it. I'm not afraid of water at all.

So the drowned boy came to our unit. And MacLean redeemed himself after the incident in October. Because he may be a materialistic fucker, but he's a genius with ventilator. He understands lungs and trauma like no one else. And the boy, after lying there for weeks, is finally waking up and responding. His physics advisor (academics, man...what planet are they from) asked--as he was laying there, vented, seizing, eyes rolling back in his head, shitting himself, "Do you think he will be able to regain cognitive function?"
"I don't know." I told him. "Maybe, after a few years. He's had a severe anoxic injury."
"Okay, I understand that," the man says impatiently, "But do you think he'll be able to finish his dissertation?"
I just looked at him. I wanted to say,'you know, really, at this point we just want him to be able to breathe by himself and wipe his own ass-that'll be success in this arena."
No clue what they were dealing with.
The parents were brought over from Tibet. I'll say this--the Chinese government got them over here fast.
They are lovely, they stand next to him and pat him and stroke him and murmur to him. When the nurses come in to tend him, they pat and stroke us, too.
Yesterday, we were able to put him into a wheelchair and wheel him into the courtyard. We parked him under the crabapple trees. I think I've written about the courtyard.
There are swallows there, they swooped and dived. The boy lifted his head and watched them...and smiled.
The professor, who, despite his annoying qualities, has been at the boy's side almost constantly, started crying.
Me, too.

a B

Did you know that naproxen and glyburide are highly protein bound? This can result in increased glyburide levels, as the Aleve competes with protein binding sites, causing hypoglycemia. I didn't know that. It wasn't anywhere in the reading, class notes, lexicomp, or epocrates--but it was on the clinical pharmacology EXAM!!!! And I got it wrong. 88%. I haven't gotten a B on a test in 6 years and I'm pissed off.

Arghhhh.

It's been an almost perfect storm at work the last two weeks, equal elemental forces converging consisting of responsibility--I charged--3 level one trauma admits, short staffed, inexperienced staff (but great attitudes--what a group)--severed limbs, unredeemable patients, severed limbs, constant diarrhea, crazy family members, and leaking rectal tubes (between my two patients I had 17 linen changes on Saturday).

I had weird dreams involving that surgeon I kind of like. I had to insert a rectal tube. He wanted to kiss me, moved a strand of hair out of my eyes. He'd also grown his hair out and looked a little bit like Brad Pitt in Legends of the Fall (a really stupid, hokey movie). "I don't have time for that," I snapped (in the dream). "We've got to get a new Zassi in you right now.!"
I'll never forget the look of disappointment and betrayal in his eyes... Then I woke up next to Jay and felt all guilty.

I told Marcy about the dream.

"He deserves a rectal tube." She said. "Maybe it would get that stick out of his ass. And it wasn't like you were having sex with him. I don't think Jay would be jealous of that kind of interaction. Unless he's weirder than you know."

He might be. I caught him lying last week. Maybe that's why I'm having dreams about putting rectal tubes in my coworkers! He did go visit the 28 year old bartender in Summerville when he was on his shoot. He had told me that he didn't even go into town. We went down to visit his son in Summerville last week. "Haley's (her name's Haley, too--can you believe it? another one!) going to think I live down here, now," he said, musingly, as we were driving. "I've been in that bar almost once a week lately."

"I thought you said you didn't get into town."

Silence. Whoops.

"I never said that."

"Yes, you did."

"No, I didn't. You're just looking for trouble."

I let a few minutes pass. Then I said, "You know, you need to accept that, now you're 53, and with the head injury and all, you're probably not cognitively intact enough lie anymore."

We choose our poison, don't we?

I had a patient who had taken to his bed. He'd just decided...that was it. Not getting up anymore. Young guy. Lay in bed. Watched MTV. Those horrible reality shows--the one with that girl with all the tattoos...oh my god, what a waste of a life. Curled up in bed. Smoked two packs of cigarrettes a day. He developed contractures. He could only turn to the right. His organs became compressed, he couldn't breathe. He developed osteopenia. His bones fractured--hips and ribs. Wore a diaper. We couldn't do anything for him. And he chose this. One day at a time. Our bodies and our lives form the shape of our minds and hearts.

Dear Reader. Life is imperfect. Stand in the sunshine. Stand and stretch and move as much as you are able. Move through your pain. Breathe deeply. Love those around you impeccably. Learn as much as you can. Serve and love your world. Forgive yourself and others. I will try if you will.

Love,
Haley