In Memoriam

Dwight and I sat in his small apartment and talked about our memories from Pine Street, the neighborhood we had first become friends and neighbors. He was grinning in a mischievous way and I knew something good was coming. “When I first met you, you were juggling outside, and I thought,” he paused to actually chuckle, “Wow, this guy must know kung fu or something if he’s crazy enough to juggle outside in this neighborhood.” That had been nearly five years ago; we laughed hard which felt really good. He adjusted his nasal cannula, paused to breathe, and ate another spoonful of the butternut squash soup my wife had made. He sighed and set it aside. “Dave, this is really good, but I just can’t eat any more. I can’t eat that much these days.” He could barely stand from the easy chair, limited both by weakness and the extreme shortness of breath he experienced as his new normal. I stared at the stains on the carpet and his pants where he had spilled some of the soup earlier. I remembered wiping it from between his toes and off his swollen legs with the same sense of affection and gentleness I did with my two year old son. It felt strange because I knew it shamed him to feel so helpless, this man the age of my father who prided himself in his ability to work with his hands, but there wouldn’t be anyone else to come by that night to help. It was the only thing left I could think of doing to preserve his dignity, something I thought about a lot those days.

There was a pause in the conversation and I asked him a question that I had been meaning to for some time. “Dwight, I’d like to ask a favor from you.”

“Sure, Dave. Anything for you.”

“I’ve been thinking of writing a book or something about my experiences from Pine Street, and I was thinking about how much I learned from you and still do about the city and your life and everything. I was hoping we could write it together, the story of our friendship, or maybe I could interview you. Would you be interested in something like that?”

He answered quickly. Yes, he would like that. Yes, I could make some recordings if I wanted to; he didn’t think he wrote very well but loved to talk and loved to tell stories and we agreed that that might feel more natural. He had been thinking about writing some things down anyways.

We talked a bit more and then I washed a dish or two and went to leave. “Love you, Dave,” he said. I told him I loved him too. It was an exchange he had taken to ending our conversations with over the past two years; it had taken some time for me to get used to, being naturally hesitant to use the L-word, but it felt both expected and natural by now.

I took the elevator down the high rise and drove home. I walked up the steps to my house and thought again about how we could build a ramp so Dwight could visit more easily and see the new home and remark on how different it was from the row houses of Pine Street we had first met in. I thought about what we might cook for him and how much salt to put in it. I did some looking for a nice voice recorder and ordered it on Amazon exactly two weeks later.

I never got to use it with him. He died a week after that, but I didn’t find out until this weekend and only did so because I found that his number had been discontinued. Two months have already passed and I missed the announcement, the interment, the memorial service. I missed everything. Continue reading “In Memoriam”

In Memoriam

The Resurrection

The nurse, the wife, the niece, and I sat together in the small family room, quietly thinking. I felt insulated from the sounds of the busy hospital even as my pager chirped a warning that our ICU was about to get even busier. I resisted the temptation to sit on the edge of the seat and betray the anxiety I felt and the urgency of the conversation. We were gathered to discuss the critical decision to intubate a patient, a man who lay struggling to breathe in a bed just down the hall. We had been trying for days to stave this moment off with a tight facemask that forced pure oxygen into his lungs, but he had been ripping it off in his confused and deteriorating state. He was tiring out rapidly and an internal clock in the back of my mind was counting down towards that tipping point when even intubation might cause his heart to stop and actually hasten his death.

I looked at the wife and remembered our first meeting a few days earlier, when the patient first crashed into the ICU. At that time, she told me how she had been living in the hospital for two weeks, watching helplessly as his first round of chemotherapy set off a series of nasty complications. She told me that the one day she went home to get some rest was the day she got a frantic phone call telling her to come back in and this time to the ICU. I told her she had permission to not feel guilty about going home and she burst into tears of relief, sorrow, and exhaustion. We talked then about his tenuous condition and how sufficient recovery to tolerate the next round of chemotherapy was difficult but not impossible.

But in the days since he only did worse. In the disorientation brought about by his decline, he was in a constant state of fear, agitation, and anxiety. And now, at the edge of his viability, it became my job as the supervising resident to tell her that we were reaching the point of extremis: that his survival depended on breathing through a tube which we might never be able to remove, that his respiratory failure came at the end of a chain of other failing organs, and that even if he survived the ICU stay it was unlikely at his age and in his condition that he would ever recover enough to tolerate the next round of chemotherapy. So I told her what she already knew and we sat still for a moment in that waiting room, listening to my pager and the muted sounds of hospital chaos outside.

Then she cried. She cried as she told us how just a month ago he had been fishing with his grandson without any cares or illness. She cried as she told us how he had just asked his son to fetch his gun from home so he could shoot himself. She cried as she told us that she didn’t want to see him suffer, that she knew it was time to let him go, but that she still didn’t want to lose him either. I watched the niece cry and even the nurse cry as we felt the force of all her helplessness and fatigue and grief.

I have rarely felt the gravity of a moment as I did then, weighing the value of every word and pause against the ticking of that clock. We decided to let him pass, to stop our modern medical torture and transition him to hospice. And even though I and every other specialist had known from the beginning that this would be the best outcome for the worst and final situation of his life, it still felt like utter and hopeless defeat.

In that moment, I asked if he was a man of faith. His niece offered that he was, and remembered that he always insisted on holding hands and praying together before meals every Thanksgiving and Christmas and Easter. So I offered to pray for them and we did. We gave thanks for the life of love that he lived and the deep affection of family that was the reason why these moments and decisions were so hard. We prayed for the release of his suffering, that in Christ our death is not final but will be overcome. And, in an unusual moment, we even had the audacity to pray for joy.

We left the room and I rushed off to set up the incoming arrival of three sick patients to the ICU. It was so busy that I could not return to the patient’s room for several hours. When I finally sat down at a computer to plug in some orders and take care of paperwork, the nurse came up to me and asked, “Have you been back in the room yet?” I sheepishly said I hadn’t, it had been so busy…

“It’s a completely different room,” she said excitedly. “Before that conversation, it was like a funeral; now they’re talking and laughing and joking and sharing stories about their memories together. I have never seen a doctor pray like that before.” I was stunned; I hadn’t expected such a change either. I stopped by the room and drew back the curtain to see it exactly as she said. I saw the wife’s face transformed, smiling even through her puffy red eyes, the great weight having visibly been lifted from her.

I didn’t cry once throughout the entire encounter but for some reason can feel the tears brim in my own eyes now as I write about it. It has been years but the memory is still clear and bright because, to me, it is the closest thing I have ever seen to a resurrection.

He is risen!

The Resurrection

Dead Bodies and Lamentations

What do you do with a dead body in the room?

My first dead patient arrived that way. He was half naked, pupils blown, head bashed in from a car accident in which he was thrown through the windshield. It was my first week on the wards as a medical student and though I had been through enough trauma alerts with the surgical team to know the drill, the brutality of it all still took me by surprise. The trauma bay was chaotic for all of twenty minutes as the team performed what they already knew would be an exercise in futility: chest compressions, central lines, bags of saline, etc. Someone had asked me to get warm blankets so I scurried around retrieving them but primarily tried to stay out of the way. Once the twenty minutes of resuscitation were over, the chief resident called the time of death and everyone simply stopped what they were doing and awkwardly shuffled out of the room. I remember standing there under the bright spotlights alone with the dead body, blankets still warm in my hands, watching as blood suddenly decided to gush out of the man’s skull and onto the tiled floor. I remember staring at the growing puddle and feeling like the most helpless and useless person in the world.

In the years since, I have been in the room with a dead body more times than I can count. I have been the one to warn the family of what was coming, whether they were prepared or willing to hear it or not. I have begged them for permission to stop CPR, to acknowledge the death as final and irreversible. I have had to make the pronouncement of death. I have watched family weep with silent tears and have had them scream at me from down the hall. I have done CPR on babies and adults. I have helped zip up the body bag. Even as I write this, my memory relives the hearing of those noises, faces, voices, lamentations.

Whether I want to or not, whether it is fair or reasonable or not, my job puts me in a position to listen to a wide range of hurt and anger and grief. It has become reflexive to absorb these narratives, in part because it makes me better at my job but also because the plainness of the suffering voice is compelling. That said, some days I come home both thoughtful and irritable, resentful of my role as a dustbin for the sorrows and troubles of others. I grouse and pour myself some seltzer over ice and sort through the emotions of others that have been laid on me.

But in some odd way, I have also come to appreciate such experiences even if I cannot bring myself to be thankful for them. In thinking about that helpless experience of watching blood spill out of a man’s head, of pushing a baby’s chest in perfunctory CPR, of shocking a dead body into convulsions over and over again, I am forced to acknowledge the brutality of death and visualize how easily the sacred becomes desecrated.

I recently heard seminary professor Dr. Soong Chan Rah talk about the Book of Lamentations, how it begins with a funeral dirge for a nation humiliated, raped, and obliterated into exile. He talks about how the book speaks about the dead body in the room, the death of the nation of Israel. It is composed in broken meter, styled to imitate a limp, written from the voices of the beaten and wounded.

How lonely sits the city
that was full of people!
How like a widow has she become,
she who was great among the nations!
She who was a princess among the provinces
has become a slave…

My eyes are spent with weeping;

my stomach churns;
my bile is poured out to the ground
because of the destruction of the daughter of my people,
because infants and babies faint
in the streets of the city.

They cry to their mothers,
“Where is bread and wine?”
as they faint like a wounded man
in the streets of the city,
as their life is poured out
on their mothers’ bosom.

- Lamentations 1:1; 2:11–12

There has been a lot of talk in the post-election season about “understanding one another” and “coming together” and “moving on.” There has been a lot of wondering about “why can’t we all just get along?”, a question that would seem honest and harmless if not for its implicit favoritism towards the dominant culture.

There are many things to lament, as there are many things that are broken, and this is legitimately true in most shades of American politics. But racism is a particular sort of devastation in our history that merits its own dirge, one that the American church has been too reluctant to sing. Think for a moment about the white nationalist conference in DC and resurgences of the KKK, then think about these words from the book, “The Cross and the Lynching Tree”:

No historical situation was more challenging than the lynching era, when God the liberator seemed nowhere to be found. “De courts er dis land is not for niggers,” a black man from South Carolina reflected cynically. “It seems to me that when it comes to trouble, de law an’ a nigger is de white man’s sport, an’ justice is a stranger in them precincts, an’ mercy is unknown. An’ de Bible say we must pray for we enemy. Drop down on you’ knee, brothers, an’ pray to God for all de crackers, an’ judges, an’ de courts, an’ solicitors, sheriffs, an’ police in de land.” Whether one was lynched on a tree or in court, the results were the same. “Lord, how come me here,” they sang, “I wish I never was born!” (page 27)

The language of lament has helped me understand what has been so bothersome about the “evangelical” Christian voice in the national politic. We talk about how the church is the cure to American culture without acknowledging its complicity in a long history of corruption and tainted ambition. We talk about our entitlements to freedom without mentioning the offal nature of slavery and oppression. We demand forgiveness and reconciliation without recalling our viciousness of speech and deed. We talk about God’s sovereignty as resurrection without mourning the abused and defiled body of Christ. We have skipped ahead to resurrection songs when the bleeding body is still naked on the stretcher.

What do you do with a dead body in the room?

What can I say for you, to what compare you,
O daughter of Jerusalem?
What can I liken to you, that I may comfort you,
O virgin daughter of Zion?
For your ruin is vast as the sea;
who can heal you?

Your prophets have seen for you
false and deceptive visions;
they have not exposed your iniquity
to restore your fortunes,
but have seen for you oracles
that are false and misleading.

All who pass along the way
clap their hands at you;
they hiss and wag their heads
at the daughter of Jerusalem:
“Is this the city that was called
the perfection of beauty,
the joy of all the earth?”

- Lamentations 2:13–15

Dead Bodies and Lamentations

Trauma: What Freud Learned About Rape

In medical school we glossed over Freud because psychoanalysis had largely become outdated. Popular culture has turned his method into a mockery; we chuckle to think of the bearded psychiatrist listening intently to some dude reclining on a sofa talking at length about the hidden sexual meaning underlying his bedwetting dreams. In the new era of cognitive behavioral therapy and evidence based medicine, the realm of the subconscious seems better studied by functional MRI scans, neurobiological theories, and data-driven analysis & interventions. To see medical professionals chasing fanciful interpretations of dreams or inkblots would now seem quaint at best and like quackery at worst. Do we really esteem Freud’s preoccupation with the psychosexual stages of children with anything but puzzlement? Unsurprisingly, I was taught to have a low opinion of Freud and consequently rarely thought about him or his theories through the rest of my clinical training.

And yet I’ve recently come to a new appreciation for Freud from an unexpected source. Continue reading “Trauma: What Freud Learned About Rape”

Trauma: What Freud Learned About Rape

Segregation

It has been about a year since we moved out of the “inner city.” It’s an experience we are still processing with many mixed feelings, among them relief, disappointment, and shame. It is a relief to be able to walk around the block without fear of hearing gunshots, to sleep at night with working heat and running water in the winter (since the pipes don’t freeze here), to not wake to banging noises wondering if we are being broken into. It is disappointing to feel isolated in our rented apartment, that even though our neighbors are friendly and engaging, our interactions tend to be brief and largely disconnected. And shame… I am still not sure why we feel that but we do.

Continue reading “Segregation”

Segregation

Anniversary of Theft

My wife reminded me that it has now been one year since we were last broken into. She was partly reminded of this because our car was broken into last week, an incident in which only a cheap phone charger and several quarters were taken. This occurred despite having moved to a “nicer” area of the city, one in which we easily enjoy walks in the park and Greek festivals and fancy burritos. It is a neighborhood where we can walk freely, a stark contrast to our old one where I whimsically described myself as sticking out like a Chinese thumb on a black man.

Continue reading “Anniversary of Theft”

Anniversary of Theft