Soot

Why is it so hard to get on that cushion? I mean, it's not like I don't know what's going to happen. It's only a 1/2 hour. But sometimes it's so hard.

I accidentally set my buddha on fire this morning. Had my incense too close to him. Jesus. If people only knew...started smelling something that wasn't "way of the heart" (the name of my incense fragrance). Maybe it's a good thing there aren't more buddhists in America. Maybe there would be more house fires if there were.

I couldn't get out of my patients' rooms while on the cushion. I kept seeing them. I have a patient with uncontrolled diabetes, who fell a few days ago while trying to fix his furnace. He was using a candle to light his way because the electricity in the house had been shut off because they couldn't afford the bill--and he fell off the stepladder and skinned his knee. Being a guy, he ignored it. Put a bandaid on it. Finally his wife noticed a funny smell and insisted on taking a look at it.

"I'm no nurse," she tells me, "but I know when something's bad, and that thing was bad." She piled him into the car at 3am and got him to our ER. He had necrotizing fasciitis. If she'd waited til dawn, he would have lost his leg.

His condition is complicated because he has pneumonia--and he has pneumonia in part because he's been living in a freezing house, using candles and inhaling soot from a faulty furnace. She has pneumonia, too, I think. She watches me suction him. Black chunks come out of his lungs. "Oh! I'm coughing those up, too," she tells me.

We've been diving--going to hyperbarics--with him twice a day to stop the spread of the infection. And daily debridements in the OR. Necrotizing fasciitis moves faster than you can imagine. Surgeons talk about opening people up and watching the infection spread under their eyes through flesh, too fast to chase with their scalpels. It's debilitating and disfiguring. This guy has no insurance. But I have to wonder, if he'd had access to stable primary care, or more simply, if he'd been able to afford electricity and heat, would he be here?

She is at his side constantly. And she never stops talking. She talks like I do, to ward off despair and silence. She talks to him, even though he's comatose. One morning she read him the room service menu. She went through every single item. "Ummm, Gregory, it says here they have parmesan encrusted tilapia. Doesn't that sound good? and you can have that with a choice of green beens, mashed potatoes, or macaroni and cheese. I'm not so sure about macaroni and cheese. That would be two cheeses in one meal and that's a little much." Coughing fit. "Oh, here's the list of beverages. Iced tea. Too cold for that. Coffee. decaffinated coffee. Apple juice. Cran-apple juice--oh, that's good! I wonder if it's 8 ounces or 4 ounces. Do you know, Haley, if the juice they have with room service is 8 oz or 4 oz?"

"I think it's 4 oz." I say, a little short. I'm trying to program the Alaris with his levophed dose and I don't want to make a mistake (levophed-leave em dead). Why we're giving a man with wounds like his levo, I don't know--but we're dumping fluids into him to make up for the insensate loss due to his extensive loss of flesh--and his pressures have been plummeting. Sometimes you choose between poisons. And it's more important to keep his heart going at this point, I guess.

"Do you think they would bring me some?" she asks.

I get her some cran-apple juice out of our refrigerator. She continues talking. I smile and nod and try to concentrate on what I'm doing.

He has 11 brothers and sisters. No one visits. But they all call. And call and call and call. And they all have something bad to say about his wife. I suggest they visit. "We're afraid we'll give him something," one of them tells me.

Finally, one turns up. Sunday. Fresh from church. She's wearing a big yellow, wool suit. She leans over him. "Oh my God, look at his nose hairs." She says to me. "Are you going to do something about those?" she demands. "How embarrassing."

"Oh, they are bad, aren't they?" his wife agrees. "I didn't even notice."

Outside the room, Yellow Suit takes me aside, "Now listen," she tells me, "I know that we have a big family and we all call, but that's just the way it's going to be. Because his wife doesn't call us. We call her, and she doesn't want to stay on the phone long, and we call the nurses, and the nurses act like they're too busy to talk to us, and we have a lot of questions. So you're just going to have to get used to us calling. And tell the rest of your people that's what's going to be happening, too, got it?"

"This is a critical care unit," I tell her calmly. "The nurses will be giving care to your brother. They'll talk to you as much as they're able. I'm so glad your brother has such a large family. I'm sure you are all giving his wife the love and support she needs during this terrible time. She's blessed."

Yellow Suit stares at me.

"And thank you for pointing out his nose hairs. Families always see the important things that we sometimes miss."

We stare at each other.

Wiz, across the pod, yells, "Haley, you have a phone call."

"Excuse me. Thank you for--"

"Now." Wiz yells.

That's my 1/2 hour.