The Taser's Edge

7 Months and 2000 Miles Later

After a week off work, I returned home from Illinois last night at 8pm.  For at least 24 hours before that I had been counting the hours until I had to return to work, laughing at the absurdity of being at work 900 miles away.  Laughing mixed with bitterness I see now.  Laughing is what I always do when it comes to impossible situations.

I was ready to return, though.  Lack of structure is hard on me psychologically, so one week is plenty of break.  After returning home, I mostly took it easy last night.

This morning, after shoveling through a mountain of email (which, yes, is better than shoveling snow), I headed for the chapel.  I was there over an hour.  I always have mixed mind about that.  I believe very strongly in prayer, and I believe that any ministry job which faults me for praying too much has its own problems.  Yet I also know that the ‘desire to pray’ and the ‘desire to take a nap’ can overlap with each other.  This wasn’t that kind of prayer.  For weeks perhaps, I have been without set aside times for prayer, which is unusual for me.  There were plenty of days where I consciously noted that I hadn’t had two days in a row where I really gave any time to prayer in a while.  I was parched, and I needed that time.

The one part of my unit’s final evaluation with less than the highest marks was attending to self-care.  I vocally disagreed with my supervisor’s assessment, but my decision to stay in the chapel was definitely a self-care decision (although not only a self-care decision).

Then I went to see patients.  There were two referrals and one other family that I had been seeing before the break.  I have been seeing that family since I started at Duke in June.  They were literally the second family I ever visited with at the beginning of my residency, and they have been at Duke continuously since May.  Fourth of July, Thanksgiving, Christmas, and a handful of family birthdays later, they are still here.  And since the end of June, I have known (or at least have constantly assumed) that he was going to die.  Nothing went right with his recovery from surgery.  Kidneys shut down, liver shut down, digestive tract shut down, depression and anxiety set in.  And for weeks, literally every heart beat and every breath has been dictated by the steady metronome of machines.  He is as healthy as a machine.  His heart and breath rates are so perfect and so pristine, that he is more ‘healthy’ than nature will provide. 

After I saw him today and talked to one of his doctors, I wondered if the miracle his family has been praying for all along is just around the corner.  I wonder if the miracle might be a good death, that God would rescue him from an end wrapped in blood, clawing for air (and this is the end which his doctor says is now likely).

In a CPE residency, one of the things we talk about so often is transference and counter-transference.  Transference is when a middle aged female patient notices that I look a bit like her son and then starts relating to me as if I were her son.  Counter-transference is when I relate to her as if she were my mom.  Most of the time it is much more subtle, and you notice it because your emotional attachment to a patient is a lot stronger than any intellectual view of the relationship can explain.

In my view, the reason my job is hard is not because people die around me, but because when they die, I somehow experience it.  I am in it.  I am with them.  And sometimes, I experience enough of their pain that I know that I am too close.  This is one of those times.  This will be one of those deaths where I need to ask myself the question again, “What will happen to you if this patient dies?” and the corollary, “Why this patient?”, as in “Why is this patient’s death and not some other death really getting to you?”

The easy and true answer is that this family has been at the hospital longer than I have.  Add up their hours since May and my hours since June, and I would guess they have been here 2-3 times as long as I have.  I introduced this family to at least three other chaplains, as the patient was shuttled from floor to floor, unit to unit.  And then the second crop of interns left at the beginning of December, and I was their chaplain again.  Add up the hours I have spent with them, and it is…well, a lot.

I’m angry about it really.  Why won’t God just kill the guy?  (A question with tone enough to show you how strongly I feel this death.)  Why won’t his family let him go?  Why can’t the doctors say, “There is nothing more that we can do.  Sorry, but we need to remove support,” and then do it and not have their labcoats sued right off their backs?  Everything is wrong about this.

What is at stake for me in this?  As I am assessing the last several months, the thread that runs through it all is this man, and I have failed him.  No, I haven’t failed him, but he is a failure.  He didn’t live and he won’t live, and he won’t even get a good death, as far as I know.  For anyone wondering whether there are fates worth than death, there are.  And for those wondering if there really are such things as the undead, there are, but they can’t walk the earth.  Their skin is far too destroyed, their legs far too weak, and their wills are snapped in pieces.  All that’s accurate about the movies is the groaning, because they can no longer speak.  If we continue on this cinematic route, just know that Darth Vader is a beautiful fantasy to real machine people.

So what is it to me?  I keep asking myself this.  What is it for youWhat is here for you?  I can give lots of answers, many of them true, but I can’t find the answer.  Maybe the truth is that there is no ‘the answer.’

A practical side.  If I see him every day, I will not be able to stay separate.  I cannot minister to the other if I become enmeshed with the other.  And I am in danger of becoming enmeshed.  I know this.  I am Harry Potter staring too closely into Albus’s pensieve; if I’m not careful I will be sucked into somebody else’s life head first.

Yet the family needs care and would benefit from daily visits.  The balance (and this is a daily rather than an anomalous balance for chaplains) is that I ask for help.  I can go twice a week, but I can ask someone else to go on those other days.  But that gives them three days and me two!, I may think.  Possessiveness is evidence that I am getting too close.  I know I’m healthy enough if I can ask somebody else to provide care to this patient alongside me.  Asking someone else also reminds me that I am not alone in my suffering with this family.  It’s a whole other reflection (and this is already three or more in one), but the reminder that I am not alone here is a reminder that at my most alone feeling, I am never alone.

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