notes from above ground

xxviii

ICU week started today. I was really expecting to hate it. It seems so hatable, doesn’t it? The threat of early mornings, rounds that never end, and being surrounded by dying people all day.

All things considered, I don’t hate it that much. It actually feels sort of comforting to be in there. I don’t know how to describe it. I guess it’s nice to be reminded of death. A nice reality check. No matter what happens, there’s always death. No matter how bad you fuck up, and even if you don’t fuck up at all, the end is ultimately the same.

The problem is that the reminder is neverending in the ICU. It takes a toll to be surrounded by death and suffering all the time. Today during rounds, one of our patients (whose heart medication had leaked out of her veins and bleached the skin around it) sobbed on-and-off for an hour. They were the sobs of a sedated lady, dry and childlike. The longer she sobbed, the more nobody did anything about it. There were a couple raised eyebrows when she started, but after a few seconds, no reaction at all. It would’ve been too disruptive for us to reflect on the sound of suffering, though it was somehow constantly in earshot no matter how far away we got from it. It’s not something we’re equipped to handle. Or maybe it’s just me.

While the woman sobbed, I gave my compulsory one presentation per day on a different sedated lady whose heart wasn’t working. The attending told me to tighten up my delivery a little and to “review the anatomy.” Way better than “you’re a stupid piece of shit,” which is sometimes the effect I have on people.

It feels weird to celebrate above ground victories like that when while surrounded by the ambient sounds, sights, and smells of the dying. How disgusting to feel that kind of relief just for having not looked like an idiot when I know that the ambient suffering hadn’t gotten any better in the meantime.

I’m sure there’s a hidden curriculum in all of this which I’m not fully appreciating at the moment. Something about the nature of suffering. I’ll understand when I’m older. For now, I’ll continue to report for duty with a smile on my face and pretend I don’t hear/see/smell my surroundings, like everyone else does. I can just trust the process and try to figure out a way to sustain as little psychic damage as possible.

When I walked through the door to the stairwell at the end of my shift today, I let out a silent scream that didn’t stop until five flights later when I reached the door to the lobby. As I screamed, I felt pure relief inside my chest. It turned into air, which went up through my windpipe, rubbing my vocal cords along the way, turning into a high-pitched, breathy sound that only I could hear. I felt like a kettle.

I think the silent scream was the release of all the neuroticism that underlies everything up there. The rubbing of my vocal cords is the sound of snapping out of my illusion of “knowing what’s going on.”

I hate the fact that we’re given permission by society to act like we know what’s going on. It feeds into the god complex. We think we’re in control, and we act like we’re in control, so the patients and their families think we’re in control, but we’re never really in control.

I watched the ICU doctor stick a chest tube in a guy today. The guy had gotten CPR, but the resuscitation efforts had broken a few of his ribs, which had caused blood to accumulate in his lungs, which is why he was in the ICU, which is where they put tubes into every hole in his face for food and breath, which makes him unable to talk. Now, he still can’t talk, and his ribs are still broken, and he has a tube coming out of his side (not his chest—which was confusing to me) slowly draining blood into a plastic bucket.

A few hours after the tube got inserted, I found out that we had forgotten to rinse it, which (according to the internet) puts the patient at risk of “retained hemothorax,” something that could kill him, and we now have no control over it.

Is it not crazy that we use medicine to save people’s lives, only to put them through even more suffering, suffering that is as horrific as it is manmade? We force them to stay alive at the cost of their ribs and lungs and ability to speak, holding them hostage while we try to fix the problems that we created with increasingly invasive solutions, and then we forget to see these solutions through, risking even more suffering than the suffering we prevented by giving him CPR.

Why didn’t I drop out? I actually can’t remember. I don’t understand why I would continue to put myself through all this manmade horror. Is this really necessary? Did I really need to learn the story of Mr. Chest-Tube-Man? Does it really do me or anyone enough good to justify collecting all this soul baggage and silently screaming down staircases? What kind of life is it to be unable to control the urge to scream at the end of the day?

I don’t know the answers to any of these questions, but I can’t help but smile. Not knowing is okay. Nobody knows anything anyway. Clearly.

It’s crazy that they made a whole occupation where you get to act like you know everything, an occupation where the objective is to save lives, thus making it the most important occupation of all, thus allowing those who occupy that occupation to force other people’s lives to bend around theirs, because it’s life and death, and isn’t life the most important thing?

I think it’s a stupid occupation, frankly. The obsession with preventing death is so annoying. Death is the one unpreventable thing, but our most important occupation—supported by the entire fabric of society—is dedicated to preventing it. What happened to acknowledging death like an old friend when it comes? What happened to preparing for the dying process so it’s not horribly traumatizing?

Enough thinking. Every moment is the same moment that has always been, and that always will be, and all I can do is to continue living in it. I’m going to McDonald’s.