Bigger Elevators Needed

I have returned from Spain. It was beautiful. It was my life.

That is a reference to the book, Nicole Krauss' "History of Love," which I read while I was there. It was the perfect literary compliment to a amazing thoughtful, beautiful, healing, renewing journey.

In the book, the parts I like best are about his love being the "happiest and saddest" at the same moment. And at the end, it says "He was in love. / It was his life." The context is lovely if you'd like to read the entire book. On my journeys through hostels and Barcelona and Valencia, I kept meeting up with it: in Spanish in a bookstore "La Historia de Amor." And then on a rainy night in Dutch read by a fellow hostel companion stuck in the storm.

I wrote pages and pages in a journal I kept there; many pages of sorting through half thoughts and emotions I must have been storing up since at least the diagnosis of lupus in May. And some even from before that. There was mud to be sifted for the lotus to grow. To be sure.

I may include some of that at a later date.

For now, I am back at work. In the medical intensive care unit--the ICU.

My re-aclimation to the United States of America was frought with travel frustrations. My plane in Philly was broken so I was stranded there for a night, though at least I didn't leave my wallet in a taxi like my part-time travel companion did on his way back. It was a good think I had that peaceful Spanish vacation aura about me. It, along with a peace I've been working very hard to regain and grow, kept me calm through all the travel hassles. I kept remembering the Hanh talk we'd attended and his book. Take time when you are stuck somewhere to meditate in your mind. Enjoy the space and time and cherish that peace. So I enjoyed the airport floor and the fact that my cell phone worked again and I could reconnect with friends I'd dearly missed. And I could sleep without my legs cramped in the middle seat on the plane. It really wasn't so bad.

The second day after I was back, I returned to work in the form of an eight hour test with 340 multiple choice questions about medicine which I hadn't done in 6 months. It was an utterly painful day. By the end, I wanted to quit this job.

The contrast between that day and Spain was stark. I realized that I don't even like thinking about that stuff that much. I realized how much I enjoyed writing and considering and letting my mind wander through my memories and jump through the futures and connections as my feet wandered through the freshly washed streets of Spain. I thought I'd quit and become a writer. I'm still thinking about that.

I came home and stared out my screen door and cried on the phone to my mom. I wanted to go back. I wanted a hug. I didn't want to feel like the out of place dreamer in a world of practicle thinkers. I don't want to still. I want to read and think and have time for three hour meals with friends and be surrounded by people who look for, and find, the good and share that with each other.

I felt better when I'd rested the next day. Sleep is a beautiful thing. Siesta or otherwise.

I continued sorting through my pictures and putting them in my Espana srapbook. I liked to fold up the random pieces of paper and cut out the pictures and glue stick them down as I remembered the place and pasted down my memories of it. I needed to process the magic and the fact that I was returning to a reality that I hadn't been sure I'd wanted for months.

My mom flew down the next day to make me a belated surprise birthday. My favorites: her homemade lasagne and apple crisp. So good. So good to see her too. I worked on my scrapbook for much of the time she cooked. It was good energy and time to share. She's feeling much better and it was good to be with her and see her so happy.

Still, I had to work the next day. I was worried.

The ICU is full of the sick patients. The ones who die. I'd had sign out already that one of my patients was brain dead and my task when I came on service would be to talk to the family about withdrawing care (she ended up dying before I got in the next day, though). Then I'd heard at the test that the ICU fellow that month was the one I'd had the worst month with the previous december on my cardiac critical care month. He was a pompus, loud man and we clashed badly. He disturbed my inner peace badly. I felt like crying again when I heard it was him I'd be working with all month.

It took me a little while to get to the mental state of seeing it as a challenge and a second chance with him. I've been through a lot and learned a lot since we'd last interacted. I would not take things personally from him. I would learn as I could and do my best. Maybe I could even try to repair some of the damage we'd caused each other before. Maybe. Survival would come first, though.

The first day went well. It was good to see many of the nurses again, and they were glad to see me, too. There was good energy among the team--or perhaps it was good energy in me. either way; it felt positive for once. I felt immune to the familiar power struggles and hiearchical games and hiding behind imagined knowledge.

One of the patients I picked up is a lupus patient. She is very sick. I cringed and felt my heart fall when the previous resident told me about her. "42 year old female with lupus nephritis, intubated, sedated, abdominal bleed from a liver biopsy looking for hepatitis." Indeed. She is very sick. She could die.

I try most of the time not to think about my own lupus in that catergory, hoping instead that I will be one of the ones who doesn't develop renal disease or need hip transplants from chronic steroids, or is unable to have children, or gets brain inflammation, or any number of other complications. But sometimes it hits too close to home. It could be me.

I knew before I left for Spain that I had fear of something in me. Something deep that I hadn't seen or known or uncovered. I cried at the church service about forgiving yourself. I cried when Hanh talked about seeing your fears and challenges as a baby, and holding them close and examining them before letting them go. And I didn't know why I cried. Something was sensitive and touching me deeply. I'd feel my throat constrict and my eyes start to swim at the some very inexplicable times and with thoughts that I couldn't complete.

I think now, after sorting through some of these emotions, my fear.

I was afraid that I would die. Or that I might still. Soon. I could still.

Today I had to pull a groin line on my lupus patient. She has been bleeding badly and I knew I'd be sitting at her bedside holding pressure for longer than the requisite five minutes. I brought a chair with me and adjusted the bed to the right hight so I could sit without aggervating my own lupus reactive arthritis in my knees. I told her mom and best friend that they could stay if they wanted. The actual pulling of the line takes only a second, though they hovered over me as I did it. The rest of the time I sat there with my hand on her femoral vein, trying to keep it from bleeding too much. Hoping for a clot to form from the factors from her damaged liver.

As I held her vein, her friend wiped away a tear from the patients' eye and held her hand. Later she would wipe tears from her own eyes and I would hold back my own as I tried to not think about our shared disease. And as I thought about how her life had changed. She'd be diagnosed only three years ago and here she was intubated, likely afraid, with her friend and her mom at her bedside telling her, "It's okay." She could die. No one wanted to talk about it; it's hard to talk about.

It's true, though. We all die. We're just not sure when. And the question becomes how to we want to spend the time we did have. I wondered what she wanted to do with her time. If we could save her.

I wanted to be the one holding her hand, not her groin. This doctor thing is difficult. Much of the time it pulls me away from my center. It used to anyway. It still tries, but I'm stronger now. I don't let it if I can help it. Still, the pulling creates a struggle.

This career is consuming. It leaves me little time to think and read and write and explore this big wonderful world and the people in it. And I don't know what time I have and if I want to spend it like this.

Sometimes I do, though. There are days I love my job; that feeling of usefullness and impact it brings. The smiles I can share and the rest I can bring to suffering. It is a position of privlage and power to effect the most vital and basic elements of life--and death.

While these world burns around me and over 700,000 people are evacuated from their homes and the fire-fighters who tried to save them are burned and intubated five floors below me, I work. Because I am "essential personnel." Schools close. Businesses close. When the world burns, there are those of us deemed "essential." It is a privlage. Yet there are time when I wouldn't mind being less important. When I would like to join the evacuees and offer what I can--even if it isn't medical care. Because it might just be time.

And there are times when I don't want to give my time so much to others. When I'd like to have some time left over for me. Time not snatched in the seconds in the empty elevator, nor the tired drive home. But real genuine time, whole days stretched out before me like a cloud. My own cloud.

When I came back from Spain, I wrote to my friend that I felt like I was coming down from a cloud and that my wings didn't quite fit in the elevator.