Screams

On tuesday, feeling a little sick but trying to get to work, I got a call from my very sick client, J. "I have bacteria in my blood," he says "I'm on a good floor, they're nice here." We talk a little and then I hear a doctor come in, who tells him they need to draw blood. For someone who has his blood drawn often, he really resists it. I can tell this doctor who I'm picturing as young and asian for some reason has already encountered this, "I'm going to have this other doctor come do it, he's really good," he says. J. is unconvinced. "He's going to bring a special machine," the doctor says. "A vein finder," I tell J. before he can panic about the machine. These portable devices use near infrared light bouncing off your arm to show the exact configuration of the veins. I think back to 1992, my training in phlebotomy, how we were clumsily stabbing our classmates for practice and how I was a favorite target as the palest person in the room. One of those things would have been like having the answer key to a test. But instead we learned to feel, not look for a vein. I remember being surprised the first time I drew blood from a classmate, at the way the glass tube got hot in my hand. We'd been practicing on dummies, so that didn't happen, but of course a 98 degree human's blood will heat up a glass tube. The new doctor shows up, I'm surprised by the strength of his accent, Queens, I think or maybe Long Island. The first doctor continues to talk him up and I encourage and eventually the client relents. But then there's another hurdle. His central line, the tube in his chest that allows them to repeatedly access his veins for dialysis, is infected and shedding bacteria into his bloodstream. It has to come out. With his low pain tolerance, this is going to be a problem. They tell him, and he immediately refuses. They start cajoling, explaining. They will give him pain meds, numbing medication. But he wants to be put completely under, which they have done before. This time, though, his body can't take it. His blood pressure is so low that anesthesia would probably kill him. They're going around and around, him insisting, them refusing, explaining that the sedatives could slow his breathing too much - and in my mind I'm at Methodist hospital, Park Slope, in a 4 person room. Two beds have old ladies in them, and one is empty because I watched that old lady die during the night as I sat beside my mother. One last inhale and then blood pouring from her nose and mouth. I got up, went out in the hall, found a nurse. One by one her Italian family arrived, standing around her body in their winter coats, sobbing and hugging, while I tried to take up as little space as possible. Once they left and it was quiet, my mother got increasingly restless. "I'm thirsty," she said, but when I held the straw to her lips she could not inhale enough to drink. Decades of chain smoking had stolen the flexibility from her lunges, balloons unable to inflate. She was on a machine called a Bipap that was doing the work of breathing. She was flailing and it pulled apart and she started turning blue. I ran into the hall, grabbed a doctor I recognized from seeing him kneeling in the pews from the choir loft high above. They ventilated her by hand while they reassembled the Bipap. I stood at a distance, watching. Later the doctor would tell the choir master what happened, that I was young but I would be OK. And then it happened again, and a third time, and it dawned on me that she was doing it on purpose. Ending her own life was not a foreign concept for her. More than once I'd come home from school, unlocked the many locks that fortified our house against the chaos of life in Red Hook, and found a suicide note on the table in her perfect handwriting on the lined paper I used for essays to be read in class. In high school, searching for something in her wardrobe, I came across a hidden book, "Final Exit" and made it disappear. But now there was no reason to protect her, not enough life to save, just the last crumbs that weren't worth scraping out of the bowl. "It's OK," I told her, "this thing is making you more comfortable by helping you breathe, but it isn't forcing you to stay alive." She relaxed then, stopped fighting and slipped into sleep. By the time the earliest light started making its way across the Brooklyn rooftops, I was ready to corner the doctor making rounds. "She can't stay like this," I told him. But he was young and scared, and he fled out into the hallway, leaving me crying silently in the chair by the bed. I don't know who called for a chaplain, which of the nurses who saw my shirt getting damp from the falling tears. A nun showed up, an older nun in a black and white habit, who took in the situation at a glance and went bustling out of the room. She returned with a doctor, who told me, "if we give her this pain medicine it could slow her breathing.." all three of us knew what he didn't say out loud. "Yes," I said, "give it to her." By the time it was full bright morning, she was drifting out away from the world, just a tiny sliver still clinging, and my Dad showed up. I had been there for more than 14 hours, and I needed to eat, and sleep. "I have to go home to feed the cats," I told her and she nodded just a little bit. When I glanced back from the hallway, my Dad was sitting on the bed with her gathered in his arms. I got back to the house, poured the chow among impatient meows and fell asleep. And then the phone rang, the old red dial phone next to my loft bed. I knew what Dad was going to say. I put down the phone, took a breath, and picked it up again, dialing Kansas. My grandparents didn't know how sick she was, she wouldn't let me tell them, but my grandfather could tell something was wrong from the early morning call. I told him, and he repeated my words to my grandmother, hovering nearby. I heard her scream and stumbled through the rest of the call. Years later, my mother's cousin, the one most like me, a short round woman who was a social worker in DC said to me, "she didn't die suddenly, did she?" and I realized that my grandparents had told everyone that she had. Back on the phone, the doctors' gentle approach was getting nowhere. I know you have to be straightforward with J. "You need to do this," I told him "Or the germs will keep spreading in your blood and kill you." "OK," he said and the doctors left to go get the supp[lies. "You can do this," I told him, "I'll talk you through it." I talked through the coldness of the alcohol on his skin, and ironic burn of the numbing medicine, and then the big pain that made him scream, screams that would echo in my mind. Afterwards, stoned from the pain meds, he kept insisting on seeing what they had taken out of him. They showed him, "it's big, said the doctor, "all that was in your chest" but he kept insisting on seeing it again. Finally it dawned on the doctor "you can't see the the bacteria, it's too small." "Oh," said J., relaxing. "You did it," I told him as he fell asleep and I took his screams with me the rest of the way to work.