Writing as patient care

I remember a rough day, one of my last days in the hospital. I had a patient immobilized from the waist down and fresh out of surgery who could. Not. Stop. Peeing. In her amnesiac withdrawal from anesthesia, she was rapidly cycling through refusing to use a bedpan and demanding a bedpan. It was madness. An hour of back-wrenching linen changes and getting yelled at.

I can not tell you now how much I miss even those days. As a complete digression, I am made crazy by the challenges faced by nurses (and all clinicians) on the hospital floor, how it is everything but the patients that drives us mad. How many of us are forced to choose between the career we worked to hard for, our calling, and our own health and family. The American Journal of Nursing addresses the concern.

But hospital or no, I observe and I care and I’ll never not be a nurse.

Today I spent a minute in the Sylvia Plath exhibit at the National Portrait Gallery. Visiting with my son for a family event I just happened to pass the small room of framed letters and photos. I dragged him in, promised a treat if he’d chill for just 5 minutes, and let him tap sounds out of the installation of bell jars while I read.

In her letter, pinned just below a smiling photograph of Plath taken 6 months prior with her two very young children, I saw the lines that made it clear why a week from that day she would be dead by suicide.

She was getting over a terrible flu. After much distress, she had left her husband with babies in tow. Fled the comfort of their country home to a flat in London. It was the first week of godforsaken February. The longest, darkest, depressionest month.

February 4, 1963
“Everything has blown and bubbled and warped and split—accentuated by the light and heat suddenly going off for hours at unannounced intervals, frozen pipes, people getting drinking water in buckets and such stuff–that I am in a limbo between the old world and the very uncertain and rather grim new.”

So here is where writing can be patient care. Always be assessing, always be educating. You can do it with a dead mid-century poet if it makes a piece of writing.

Plath is in a volatile state, the responsibilities of motherhood on her shoulders, just separated from the comfort and support of friends and familiar places. The pipe freezing signals her loss of control. Her limbo between old and uncertain and grim? An expression of hopelessness.

It’s no revelation that Sylvia Plath was depressed a few days before her suicide. But by seeing her as not an hysterical artist inclined to shuffle off this mortal coil at a moment’s notice, and instead as a person, mother, a sufferer of a common condition, she is a

I recognize her words as if they were my own read back to me. Because they were my own, not long ago. The remark “I long to have somebody really play with and love the babies…They are so beautiful and dear and will in effect have no father.” This kind of loneliness, where you seek for someone to share love for your precious child, is crushing. And in the worst of depression: losing the ability to play with you babies, lacking energy, lacking interest. Having failed to mother, life’s most important task, why keep fighting? For me, someone noticed. And they got me help.

Hearing words like those of Sylvia Plath in her last days come from the mouths of friends and family should spur action. Recognize a mental health crisis. Help us take care of each other better. Be there at the bedside.

And as a writer, considering anyone who reads this my beloved patient, now you know. I’ve told a story that educates you. Listen for that tenor of in the speech of the people you care about. And to recognize it in yourself. Like a good nurse, assess, then act.

Also, why isn’t February Mental Health Awareness month? It is rough out there, folks. Take care of each other.

Poems for the MRI

No matter how much time I do in the MRI I always go in a nervous wreck. My favorite writer and spirit guide David Rakoff (whose death nearly three years ago from a sarcoma secondary to radiation treatment for lymphoma in his 20’s has left the saddest and most fearful absence) gave some fantastic advice about surviving time in “the tube” in an interview well before I had regular dates with the scanner. I’ve taken it to heart. Keep your eyes closed, breathe, and recite your favorite poem to yourself.

As a new nurse let me remember that sending a patient for scans will become routine for me, but it will never be for them. Let me validate fears and take time for words of comfort and advice (eyes closed, someone is always watching out for you, it gets warm in there, it is very loud, think about what music you’d like to listen to, know you are safe).

David Rakoff recites his favorite poem “Letter to NY” by Elizabeth Bishop:

I recite mine “Birches” by Robert Frost (one exhausted take, please forgive):

Neil Gaiman recites “Jabberwocky” by Lewis Carroll:

In my opinion, a memorized poem is one of the best things a person can have. Useful in any number of situations.

An inscrutable brand of optimism and another poem.

This year: some victories and some defeats, human race. But we are brave and we adapt. We recycle our garbage. We try again.

And if that doesn’t do it for you then know inevitably just like every dominant species before, eventually we’ll be gone. This beautiful blue marble will subsume us and our refuse and something new will get a few spins around the sun. (Then the sun will turn into a red giant and then a white dwarf I think and things kinda fall apart? Don’t worry we’ll all be dead.)

YES I AM an optimist. Don’t give me a hard time.

Between the time that I knew I had melanoma with not great survival statistics and my first surgery (a few weeks nearly a year ago) I would do some yoga every night and lay in corpse pose and think about dying. The uncoupling of my molecules and rearranging of my atoms and how that would be a good way to stay on in this world. I’m not gone I’m just different.

Weird mantra, right? Weird times. And I do believe it, the conservation of matter. I’m a gardener (though looking upon my gardens would make Martha Stewart throw up). Composting is a feature of life here and using it as a metaphor for purification and renewal scratches an itch. This is more a spring poem, but here it is in the spirit of the renewing the year.

Excerpt from Walt Whitman’s Leaves of Grass, “This Compost

3.
Now I am terrified at the Earth, it is that calm and patient,
It grows such sweet things out of such corruptions,
It turns harmless and stainless on its axis, with such endless successions of diseas’d corpses,
It distills such exquisite winds out of such infused fetor,
It renews with such unwitting looks its prodigal, annual, sumptuous crops,
It gives such divine materials to men, and accepts such leavings from them at last.

Poetry Monday.

image

Enlightenment

BY NATASHA TRETHEWEY

In the portrait of Jefferson that hangs
        at Monticello, he is rendered two-toned:
his forehead white with illumination —
a lit bulb — the rest of his face in shadow,
        darkened as if the artist meant to contrast
his bright knowledge, its dark subtext.
By 1805, when Jefferson sat for the portrait,
        he was already linked to an affair
with his slave. Against a backdrop, blue
and ethereal, a wash of paint that seems
        to hold him in relief, Jefferson gazes out
across the centuries, his lips fixed as if
he’s just uttered some final word.
        The first time I saw the painting, I listened
as my father explained the contradictions:
how Jefferson hated slavery, though — out
        of necessity, my father said — had to own
slaves; that his moral philosophy meant
he could not have fathered those children:
        would have been impossible, my father said.
For years we debated the distance between
word and deed. I’d follow my father from book
        to book, gathering citations, listening
as he named — like a field guide to Virginia —
each flower and tree and bird as if to prove
        a man’s pursuit of knowledge is greater
than his shortcomings, the limits of his vision.
I did not know then the subtext
        of our story, that my father could imagine
Jefferson’s words made flesh in my flesh —
the improvement of the blacks in body
        and mind, in the first instance of their mixture
with the whites — or that my father could believe
he’d made me better. When I think of this now,
        I see how the past holds us captive,
its beautiful ruin etched on the mind’s eye:
my young father, a rough outline of the old man
        he’s become, needing to show me
the better measure of his heart, an equation
writ large at Monticello. That was years ago.
        Now, we take in how much has changed:
talk of Sally Hemings, someone asking,
How white was she? — parsing the fractions
        as if to name what made her worthy
of Jefferson’s attentions: a near-white,
quadroon mistress, not a plain black slave.
        Imagine stepping back into the past, 
our guide tells us then — and I can’t resist
whispering to my father: This is where
        we split up. I’ll head around to the back. 
When he laughs, I know he’s grateful
I’ve made a joke of it, this history
        that links us — white father, black daughter —
even as it renders us other to each other.

Natasha Trethewey, “Enlightenment” from Thrall. Copyright © 2012 by Natasha Trethewey.

Where the strength comes from.

This week has been crushing. Just crushing. I’ve been looking for something to settle the outrage. It’s the stuff needed by everyone who practices moral distress for a living. The things that get you by when 5 out of six patients in the ICU are bodies begging to be let die. When you feel helpless, without recourse, exhausted. When the news is just so bad.

Breathless diatribes to friends and family members do not work. Also, they are not appreciated.

Trolling twitter is an exercise in futility and will prevent you from sleeping at night. Not recommended.

So after alienating all people IRL and on the internet, I went to the books. My college roommate gave me a Maya Angelou book of poetry for my 20th birthday and I am forever grateful. (Although that night the only thing I was was debauched, later I was grateful. What a cool roommate). Angelou was given a diet of abuse and society’s garbage and still grew into a sterling woman, poet, author, activist. I mean a true gift to the human race. I could listen to her forever, but this excerpt from a Fresh Air interview where she talks about discovering the universality of poetry and recites a Shakespearean sonnet (spur of the moment, from memory) knocks. me. back.

*Listen to the entire Maya Angelou interview

This is what is doing it for me today.

Poetry from the AIDS Epidemic, another for World AIDS Day

Excerpt of “Atlantis” by Mark Doty
About his partner with AIDS

 6. NEW DOG
Jimi and Tony
can’t keep Dino,
their cocker spaniel;
Tony’s too sick,
the daily walks
more pressure
than pleasure,
one more obligation
that can’t be met.
And though we already
have a dog, Wally
wants to adopt,
wants something small
and golden to sleep
next to him and
lick his face.
He’s paralyzed now
from the waist down,
whatever’s ruining him
moving upward, and
we don’t know
how much longer
he’ll be able to pet
a dog. How many men
want another attachment,
just as they’re
leaving the world?
Wally sits up nights
and says, I’d like   
some lizards, a talking bird,
some fish. A little rat.
So after I drive
to Jimi and Tony’s
in the Village and they
meet me at the door and say,
We can’t go through with it,

we can’t give up our dog,
I drive to the shelter
—just to look—and there
is Beau: bounding and
practically boundless,
one brass concatenation
of tongue and tail,
unmediated energy,
too big, wild,
perfect. He not only
licks Wally’s face
but bathes every
irreplaceable inch
of his head, and though
Wally can no longer
feed himself he can lift
his hand, and bring it
to rest on the rough gilt
flanks when they are,
for a moment, still.
I have never seen a touch
so deliberate.
It isn’t about grasping;
the hand itself seems
almost blurred now,
softened, though
tentative only
because so much will
must be summoned,
such attention brought
to the work—which is all
he is now, this gesture
toward the restless splendor,
the unruly, the golden,
the animal, the new.

Mark Doty, “Atlantis” from Atlantis: Poems. Copyright © 1995 by Mark Doty.
Source: Atlantis (HarperCollins Publishers Inc, 1995)

The burn of the beam/For thirty-three days/Day after day/Of high-energy rays

Writing and doctoring/nursing are twin professions in my mind. It makes perfect sense that the two things I love most in this world are literature and medicine.

What a Sisyphean effort–both pursuits–spending all hours of the day and night fighting against entropy, suffering, and for your efforts being sometimes baffled at moments of transcendence. Making sense of this big mess of human stuff.

Poets, doctors, nurses, practice in the space between what we know as fact and the mystery of pretty much everything else. It’s a magical space, and for many people I think it must be where god lives. It’s where I keep cellular respiration and Leaves of Grass.