This is what the things can teach us:
to fall,
patiently to trust our heaviness.
Even a bird has to do that
before he can fly.
Rilke - The Book of Hours II
Through the empty branches the sky remains.
It is what you have,
Be earth now, and evensong.
Be the ground lying under that sky.
Be modest now, like a thing
ripened until it is real,
so that he who began it all
can feel you when he reaches for you.
Rilke, The Books of Hours II
One never knows what the day may bring. This phrase can portend excitement - anxiously awaiting birthday gifts. In this case, as I am using it, it is esoteric and existential. The day that starts like any other – but proceeds in a fashion that could never have been anticipated.
Like many of my patients in the neurocritical care unit, the day started as any other,… until the family received a call that their loved one collapsed at work. The family is left to reconstruct the time leading up to the event. Was there something they had not seen? And, unfortunately, they must begin down a road that they would have been happy to forgo at all costs. The journey of a future beset with a serious illness that would change their lives forever. The family may be asked to consider what their loved one would want. Would, if he could speak for himself, chose to continue in this life. Meanwhile, a specialist from each body system offers hope. “We could do this … “ is well meaning, but through a narrow lens of one body system.
Until recently, I dealt with these questions at a remove. Not without empathy and compassion, but neither was this my family. Recently, my remove was removed. My husband called me home from work, EMERGENCY the text read. When I was safely home, my husband cried as he told me his parents had been in a horrific automobile accident. His mother had called him from her cell phone. She didn’t know any details and was in shock. The nurse filled my husband in - there had been an accident, his mom was taken to the local hospital. His dad life-flighted to a trauma facility. His mom had been sleeping, she didn't know how it happened. She woke up in the hospital.
After I was home, my husband received a call from a doctor caring for his dad, Charlie. He introduced himself as a neurologist. He had evaluated Charlie. He asked Geoff if there was a reason his dad was a DNI. “Does he have cancer, an incurable illness?”. Geoff, the oldest son, advised the doctor there was not any illness. The neurologist proceeded to tell Geoff that his dad had suffered a brain bleed. It was small and amenable to surgery. He went on to say that when he evaluated Charlie he was able to talk and move his right side easily. The neurologist thought he could do very well with surgery, but he would need to be intubated to complete the surgery. Geoff gave permission to reverse the DNI.
As the physician spoke, I imagined Charlie, an affable man, lying in khakis and a button down on the gurney. In my imagination he talked and laughed with the doctors. I guess the imagination and the intellect are not often connected. It was only in retrospect that I recalled that he, the neurologist, had said Glasgow coma scale 13. I had forgotten about the lifeflight, the accident. I regret that I had not asked if Geoff could facetime his father before making the decision. We heard small bleed, small surgery, quick recovery. Geoff and his sisters agreed to the reversal of the DNI. HIs mom had said the same. Geoff took the next flight to be with his parents and sisters across the country.
Charlie made it through surgery, a small drain emerging from the area, the only evidence. All would be well, a bump in the road.
It was only the next day when the orthopedist requested permission to place several screws in Charlie’s neck and spine, the rib fractures would heal, the orbital fractures would have to wait for now. It was only when the orthopedist gave this news that I came to my senses; they don’t life-flight someone for a band-aid.
Each moment the medical train took on new specialists, cardiology, urology, nephrology, pulmonology, and with each rider the train gained speed. With trepidation, I gently counseled my husband’s family to seek a palliative consultation to help them sort out all the pieces and make decisions. The ICU was mystified - so soon, it had not been 24 hours, but they agreed. The initial meeting was positive and hope was rich in the air. The neurologist led the meeting.
The next day, as I was working, Charlie came to visit me. He was talking and laughing. His voice was so clear over my left shoulder. I whipped my chair around, so happy to see him. So happy to know that the previous days had only been a nightmare that was ending. I turned around quickly, but the spirit had vanished and where I heard speech, only empty air remained. That night, as I walked the dog, the full moon gathered me up in its arms. My brother, and my father, whom I know in the full moon, reassured me that they would care for Charlie.
In the morning my husband called after spending the night with his dad. He was concerned. His dad was on 3 medicines to keep his blood pressure up. The alarms rang all night. They wanted to start dialysis. I listened as he grieved. I walked the fine line between professional and wife. I asked for permission, when it was granted, I asked Geoff to consider how much his dad would want to go through for more time. I provided more questions for him and his family to ponder. I promised to support their decision. He and his sisters talked. They asked for no further escalation of care. The medical train looked at the family in alarm. “Were they sure?” They were. The medical train, still full of promises, reluctantly came to a stop.
The family gathered and said their good-byes. Charlie took his place in the fullness of the moon.