The Ubiquity of Light

Intensive Care Pulmonary Embolism
My heart would try to pump blood against a clot blocking the way. It would work harder and faster until it couldn’t work anymore. The blackness would descend and I would cease to be.
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I don’t remember if the sun graced the day I found out a blood clot big enough to kill me lodged itself in my lungs. Nor did I realize how much I had yet to learn about myself.

I lay on the ER gurney isolated by a curtain. Hushed voices hissed from the central nurses’ station. I heard words similar to ones I had whispered to colleagues when I believed patients and families couldn’t hear.

“She might have a PE. Nothing’s abnormal, but the doc ordered a chest CT, PE protocol. She’s scared.”

Of course I’m scared. Angry too.  I’ve done everything right. I don’t eat beef. Work out four times a week. Watch my weight. And I’m still short of breath all the time. I’m not THAT old. At fifty-two I used my age to rationalize the subtle, nagging breathlessness. Or better yet: It’s the stress of a new job. You never should have traded ICU for a desk.

I looked at the monitor. Heart slow, but regular. Oxygen level 98%. A machine displayed a blood pressure within range for me.  Just give me some Xanax and send me home.   considered suggesting it until I heard more conversation.

“She’s just started a new job. I bet all she needs is a little Xanax.”

My anger amped up. I could think the Xanax way, but not some judgmental nurse who didn’t know me. Had it not been for my pushy secretary, I’d still be trying to make it through the day rationalizing why I was short of breath. A typical bad nurse-patient breaking every rule she expected her patients to follow.

A transporter snatched back the curtain. “I’m taking you for your CT.”

I had accompanied countless ICU patients to the CT room, a cold, dimly-lit, barren technological cave. The circular mouth of the machine reminded me of Audrey, the people-eating flower, in Little Shop of Horrors. I conjured up all sorts of craziness. I searched the wall for a body disposal chute. The darkness ignited a burst of creative chaos.

I noticed a phone on the wall. “Can I make a quick call?”

“In house?

“Yeah.” I dialed the number to my old unit. A nurse I worked with for years answered. “Kathy, it’s me, Cindi.”

She asked the usual polite questions of respectful colleagues who were not best friends.

“I’m having a CT. They think I might have a clot. If you hear a Code Blue down here promise you’ll come.” Finally the truth. I believed something was wrong that could kill me. I realized it in the most poorly equipped, lonely place in the hospital. If something happened during the exam, I was dead.

“I’m on my way down.”

The tech settled me on the table, covered me with blankets, and tucked a pillow under my knees. I jittered with adrenalin. Before the machine started to whirr, Kathy appeared.

“I’ll be behind the glass. Nothing’s gonna happen.”

The machine swallowed me. It whined, then roared, a washing machine on steroids.

The robotic voice of the machine ordered “Breath in. Hold your breath.” I was so afraid, so awkward in my new role, I exhaled before the voice issued permission, tried to take it back, but knew the machine didn’t wait. It moved on to the next slice of me.

“I’m injecting the dye. You’re going to feel a rush of heat. You may feel like you have to pee.” The tech said.

The dye hit me like a torch. The inside of my thighs and crotch burned. I swore hot urine drenched my skirt. How would I ever get to the car? I was so ashamed and thought back to the first grade when I peed in my pants on the short walk home.

“All done.” The tech announced.

I patted the back of my skirt. Dry. Whew.

Kathy hugged me and helped me back onto the gurney.

“Thanks so much. It’s scary down here.” I wanted to tell her I imagined my own cardiac arrest. How I saw no suction, a Code team slow to find the room, broken ribs from CPR, and my worst nightmare, a dead brain inside a living body.

“Let me know what they find,” Kathy said.

Back in the ER, I prepared to go home, put on my shoes, my jacket, fiddled in my purse for my keys. I checked the monitor one more time. Normal. I hoped my husband would arrive before I left. Then subdued voices seeped under the curtain, like voices heard only by the most vulnerable characters in B-rated horror movies. I recognized the voice of a doctor I’d worked with for years. My doctor.

“Get that Sat monitor and blood pressure cuff on her. Don’t let her get up. And find a bed in the ICU.”

They’re not talking about me. I leaned over the side-rail and listened.

The doctor pushed the curtain back. He cocked his head, laced his hands, except for the steeple he made with his index fingers, which he pressed against his lips. “You have a big-assed clot with tinier ones showered to the right lung. Do you mind going to the ICU where everybody knows you?”

Where was my husband? God I needed him. Transitioning from nurse to patient, the mundane became foreign. I listened for the step, swish, creak of my husband, who walked with a brace, but had the power to give me courage.

Dalt arrived before the ER crew transported me. 

The window in my ICU room faced an exhaust fan. Pigeons roosted in its shadow. As a nurse I watched them mate, build nests, lay eggs, and nurture their young. Patients said it helped them pass the time.

Joe, nicknamed The Ayatollah thanks to his white bird nest of a beard, handed me some electrodes and turned away. He was embarrassed. I didn’t care who applied the patches. A part of me surrendered to being a patient. A part fought to maintain my professional persona.

I had been at my new job less than four months. I called my boss. “Are you gonna fire me?” I touted a glib version of my admission to ICU once my job security was established.

I called my mom. “I’m okay.” The nurse in me provided false reassurance. “You don’t need to come. I’ll call you tomorrow when I know more.” Check. The worst call done.

I called my best friend in L.A. then left a voice mail for my wayward son.

It didn’t occur to me that I was taking care of business, something I witnessed patients do “just in case.”

Dalt held my hand. His presence reassured me. Rebound fatigue drained me. Finally I sent him home.

“I’ll be okay. Would you bring me some of our coffee in the morning?” I assumed I would still be alive.

In the dark I watched the monitor. The alarm sounded from time to time because my heart rate dropped below the pre-set limit, but my oxygen level never changed. Modern hospital beds live lives of their own. The mattresses breathe, sigh, and shift. I wanted to be a “good” patient, undemanding and not micro-managing my care. I pressed the call light.

“Hey Joe. Do I have any Xanax ordered?”

If blushing made a sound it would be Joe’s mumble. He brought my little white pill and a glass of water. “Thanks.”

In a room lit only by the lines on a monitor and lights reflected from the hall, death lurked in every corner of the room, a stealthy sentinel as attentive as any nurse. It waited for me to make a mistake.

I had already ignored its early warning.

One day I had helped Dalt move a base platform for a storage shed. We lifted on the count of three. I couldn’t breathe and white lights burst against a sudden backdrop of black. I dropped my end, rested, and we tried again. Death toyed with me that day.

Now I knew its plan. My heart would try to pump blood against a clot blocking the way. It would work harder and faster until it couldn’t work anymore. The blackness would descend and I would cease to be. I watched the monitor. I feared sleep.

How many of my patients had been afraid to go to sleep? How many had I pacified without comprehending their reality? How many worried about daily responsibilities while trapped in death’s penumbra? And what was one of the first calls I had made? My stupid job. I wanted a chance to revise my life.

My introspection didn’t matter. I didn’t care about anything but living until the next day.  I lost my identity as a wife, mother, daughter, nurse, and became just someone who wanted to be present.

Sunlight marked a new day.  If I could go back to work. If I could go to the gym. If I could wake up and pat my husband’s naked rump and pull him close to me. Then I’d know I was okay.

The last time I had peed was before the CT scan. I dreaded putting on the call light.  The ICU had portable commodes. I didn’t know my nurse for the day. I did know what passed for privacy. Half-pulled curtains allowed for bare-assed flashes. I knew of the employee’s bathroom behind the nurses’ station. But I was no longer an employee.

I cursed myself for changing jobs, for leaving my comfort zone, for not having a place to pee. My body’s betrayal infuriated me. It landed me in a place where identity comes from a medical record, where personal control is checked on admission, and where privacy means anyone can enter your room at any time. The focus of my attention was reduced to bodily functions. I was human after all. And would I ever feel like I could catch my breath?

My bladder screamed for relief.  I fished the call light from the beneath the sheets and pressed the orange rectangle with the nurse’s cap.

At the bedside, the one nurse I most wanted to emulate was Dorothy. She anticipated every aspect of a patient’s needs and practiced dogged vigilance. She always got the sickest patients. I am not that sick. Somebody else must need Dorothy more than I do.

I skipped the cursory platitudes usually exchanged between familiars. “This is so embarrassing but I really have to pee.”

“You at least have bathroom privileges. Let me get the commode.”

“I wish you didn’t have to do this.” Dorothy had been a nurse as long as I. We looked a lot alike, light hair, minimal make-up, tall, and always wearing utilitarian, thick-soled shoes. Together we had cleaned the biggest messes. It was part of the job. However having someone I knew empty my commode felt too intimate, almost like a violation, with me committing the foul. “Can I go to the sink to wash my face and brush my teeth?”

“No. Not for another twenty-four hours.”

I sat on the commode. Dorothy pulled the curtain and shut the sliding glass door as she left the room. Relief came in the form of liquid thundering on plastic. I believed the sound must have spilled out into every other room. Bedrest for twenty-four more hours. I thought I’d be going home today. Where’s Dalt?

Dorothy knocked before she came back into my room. I appreciated the subtle gesture of respect often omitted due to time constraints of busy nurses. It validated my emotional trauma of being a patient, of losing myself.

Once I settled back in bed, Dorothy set me up with a basin of water. Bathing in a basin. Disgusting. I needed hot, pulsating water, a good cup of coffee, and a breath that satisfied my air hunger. Each breath I inhaled felt like it passed through a wet washrag, a self-imposed waterboarding.

In the past, I’d thought about suicide; depression stalked me as an embodied stranger. I developed a plan. No pills, too unpredictable. Wrecking the car. Too much a chance of a horrendous survival. A gun placed at my Adam’s apple. A sure thing. So I never bought a gun. I saw suicide as an exit strategy. If life got to be too much, I could end it without screwing up the ending.

Hearing the results of my CT scan made death real. Suicide lost its appeal. Death didn’t tease; it hunted with one purpose. I knew sightless eyes, the feel of cold, rubbery skin, the mottling caused by a heart at a standstill, the final rattle of the last breath bubbling through the airway. I’m not ready to go. I sat in bed, watched my monitor, took my blood thinning injections, and waited.

I had heard patients bargain to live until the birth of a grand-child, a birthday, or a marriage. I wasn’t sure what milestone I wanted to experience, but I bargained to the omniscient Oz behind the curtain. God? Maybe. Some higher power? Perhaps. Out of my control? Absolutely. The powerlessness unnerved me.

As a nurse I squared off with death using science, common sense, and experience. But swaddled in the sheets of my ICU bed, I possessed no weapons, only my dependence on others.

Finally Dalt came.

“Where’s the coffee?” I looked for our jumbo thermos.

“I brought the newspaper. Thought it would take your mind off things. But I wanted to check with the nurses to make sure it was all right.”

“I told you it would be okay.”  I ground my teeth. My jaw quaked. My head throbbed with every heartbeat. No coffee. God I really am a patient. What the hell? Why don’t I just blow my brains out? Wait. No way. I take that back.

Dalt fell asleep in a recliner by my bed. The smell of bacon came up through the air ducts from the kitchen. I heard the flush of the hopper in the dirty utility room. The pigeons hovered around the exhaust fan. Their wispy cream-colored down fluttered in the updraft like snow. “We have a Code Blue in…” an operator announced overhead. I checked my monitor to make sure I wasn’t suspended out of body looking down.

I glanced out the window. Everything had changed. The sun, a dollop of gold in a crisp azure sky, illuminated my mortality.

 

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