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

Failing Faithfully: Created, Fallen, and Waiting

[This is an advance post in a series from the ESN blog. You can find the first part here or here.]

In the first post of this series, I was ruminating about a patient who had a rapid decline in health and social circumstances, culminating in a recent scan that showed the possibility of cancer even while he was struggling with homelessness. It was a bleak situation that caught me off guard because I was not expecting it and was grieved to think of what it would be like for him to die alone.

He has since died.

Continue reading “Failing Faithfully: Created, Fallen, and Waiting”

Failing Faithfully: Created, Fallen, and Waiting

Failing Faithfully: The Futility of Medicine (Scholar’s Compass)

hospital photo
Photo by Edu Alpendre

It was stunning news. I listened with disbelief as my colleague described how a patient of ours, in whom we had uncovered a host of serious diseases over a few years, was now newly diagnosed with cancer after an incidental scan. In addition, his social supports had been eroded and I thought about what it would be like for him to die from a vicious terminal disease while alone and homeless. He would not be the first patient for me to watch die in such a way.

Continue reading “Failing Faithfully: The Futility of Medicine (Scholar’s Compass)”

Failing Faithfully: The Futility of Medicine (Scholar’s Compass)

Despair

“He wasn’t a big time drug dealer or anything, you know? He didn’t have anything worth taking. I knew him.” My neighbor stopped for a moment, clearly shaken and deeply unnerved. “Why did this happen to him? We grew up together…”

His voice faded and we sat in silence. It was twilight in summer and one of those ordinary and warm and therefore active evenings in the neighborhood. I watched as people roamed up and down the street, meandering without any goals or focused ambition, simply enjoying the night and occasionally tossing my neighbor a casual greeting. He is typically gregarious and outgoing, the life of the party at nearly every party, but in those moments he barely responded.

I had come home from a long and late shift in the hospital, a place where it is not unexpected to spend time with those who are dying. I have gotten used to sitting in the silence and humidity of grief. And so I found myself listening to my neighbor tell me the story of a young man who had been shot to death in what was rumored to be an unusual mugging. I was listening to my friend as he struggled with the arbitrariness and injustice of the event, which was not uncommon.

And I was shocked. Not because it had been the third homicide in Wilmington in two weeks, but because he himself had been mugged at gunpoint around then and yet all he could talk about was how disturbed he was about the death of someone who was, at best, an acquaintance.

“I just don’t know. This world… it’s crazy. I don’t want to be here any more…” I could hear the hesitation and weight in his voice. He had welcomed me to the block, took me in like a friend, talked about me like family, and yet even so, the same neighborhood that had brought us together was, in its unpredictability and volatility, now threatening to tear us apart.

What is it like to live in the inner city? It is intense and very much like residency life in the hospital. It is about making faster friendships and deeper loyalties than you thought possible, with people whose very lives can end in a single bad night. It is a life that is difficult for spectators to understand, and therefore one that they may feel entitled to pity or to mock. And it is like work never leaves me alone, that all the joy and grief that comes from living as if your life depended on living and doing things together can come to such a senseless end…

No wonder we sat in silence, watching the electric street lights wash away the fading day.

memorial
Street memorial. Christe eleison.

Despair

Death and Resurrection

He was a young man, and I could see fear in his eyes as he gripped the railings of the bed and struggled to breathe, sucking in heavily through the plastic mask feeding him oxygen. His body was wasting away from cancer, and the infections that had crept into his lungs were now forcing every compensatory mechanism into extremis. He wanted to fight and live, but there was little left for the ICU to offer. I had been pleading with him for days to consider hospice and a more peaceable passing at home where he could be surrounded by family and friends, but to him that meant giving up.

He was a young man …

So we had continued to do everything, and as predicted we eventually came to that point where every biomarker and technological parameter heralded physiologic disaster. “Your breathing cannot hold on its own. We will need to intubate you soon, but your body is so sick that we will probably never be able to take the breathing tube out.” I paused. We had had this conversation before. “Do you still want us to do it? I need to tell you the truth; you will almost certainly die either way. If we transition you to hospice, you can go home and pass away with your family and friends, and we will make sure that you are comfortable. But if you still want us to do everything — intubation, CPR, shocks — you will still die, but it will be here in this hospital, and it will be brutal. Do you want us to intubate you? Do you want CPR?” He nodded vigorously, still afraid, still adamant.

He was intubated. Continue reading “Death and Resurrection”

Death and Resurrection

I have never met Shyheim Buford

I have never met Shyheim Buford, a seventeen year old young man who, by all accounts from my roommate, was a kind and lively teenager, the sort who was and would have been a role model for the younger ones in our neighborhoods here in Wilmington, Delaware. He was even a street leader once in Urban Promise, working with elementary school kids in after school tutoring and activities and joy. It is not an easy thing to develop a good reputation, but that is exactly what my roommate, whose job is working with youth in the city, described about him.

I will never meet Shyheim Buford in this life because he was shot fifteen times to death. According to the word on the street, he was being robbed at gunpoint but managed to knock the gun away and run. He almost got home, but someone (perhaps even more than one) chased him down and shot him to death. They shot him fifteen times, so the story goes though the newspaper only describes four or five. Either way, he died on the scene.

Below is a map of shootings in Wilmington over the past year alone. It is updated roughly once a week by the state newspaper, and this death is too recent to be shown here. It also does not show the two men shot less than 24 hours later around the same block, which occurred despite friends urging on Facebook that there not be “retaliation.”

Even while typing this, I heard a single shot ring out somewhere close enough to take pause. Would I read about another Shyheim in the newspaper tomorrow? Will my own neighbors or friends or my self become a similar statistic some day?

In church today, the sermon was about Jesus’ words on worry:

And [Jesus] said to his disciples, “Therefore I tell you, do not be anxious about your life, what you will eat, nor about your body, what you will put on. For life is more than food, and the body more than clothing. Consider the ravens: they neither sow nor reap, they have neither storehouse nor barn, and yet God feeds them. Of how much more value are you than the birds! And which of you by being anxious can add a single hour to his span of life? If then you are not able to do as small a thing as that, why are you anxious about the rest? — Luke 12

There is a fine line between living a worry-free life and living a fatalistic one. I struggle with the difference every day, bouncing between a hospital where we are resuscitating or pronouncing dead patients on a regular basis and a neighborhood where it feels like more of the same. On many days, I struggle with feeling the victories of “helping” people who recover just as much as I feel the sorrow of “losing” those who succumb to their illnesses. It feels as if I cannot accept the responsibility of one without the other, and consequently I waver between feeling proud and feeling guilty even as I realize that I can never claim full credit for either.

The very next passage of Scripture surprised me, even though I had read it many times before:

Fear not, little flock, for it is your Father’s good pleasure to give you the kingdom. Sell your possessions, and give to the needy. Provide yourselves with moneybags that do not grow old, with a treasure in the heavens that does not fail, where no thief approaches and no moth destroys. For where your treasure is, there will your heart be also.

What do these words mean to me? It says that what I long for has already been promised: that all of the angst and grief and deep longing for that which right and true is not wasted, but instead deepens my moneybags, the intrinsic capacity of my soul to one day be filled with a future joy that cannot be robbed, murdered or destroyed.

Christe eleison! Shyheim, I look forward to the day when we will become true neighbors at last.

Shooting map
I live somewhere between the numbers 18 and 6
I have never met Shyheim Buford

Leave It There

[I originally wrote this as a medical student working in the ICU. It’s one of my most haunting memories and comes to mind every time I work in the intensive care unit.]

“I thought I could beat the ICU, you know?” My resident looked into the distance abstractly as he spoke, talking to himself more than to me. “Sometimes you think you won’t let it get you down, but you can’t. It always wins.”

I wondered what he meant by winning. Did he mean getting to leave on time? Did he mean keeping a positive attitude? How can you “win” in the ICU? I thought about all of the patients we were caring for. A comprehensive list of their names was scrawled on a big whiteboard, a canvas where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity. The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard: successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently to squeak out a new set of letters.

The resident’s pager went off. There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock. Of my sixteen hours on shift, there were two remaining. Then one. Five minutes. Finally my resident dismissed me. “Go get some rest,” he said kindly, scanning the computer screen and mechanically punching in orders. “All that’s left is paperwork. Nothing more for you.” As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU. I walked down a quiet hallway, paneled on both sides by glass. The view on the left faced out into the cold, dark, northeastern night. The right faced the surgical ICU waiting room, which remained lit with muted, tubular fluorescent bulbs. I glanced in and was surprised to see someone still waiting inside.

She was sitting alone. Her eyes were puffy and red, but dry. They looked as if they had been that way for a long time. A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward with a palpable heaviness. Her motionless presence made the room seem more static than if it had been empty. Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do, and that he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move. I got in my car and felt immensely grateful that I could simply drive away. I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room. I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she’s gone, ohmygod she’s really gone.

****

So tempting to take up a crown
of guilt around my head
and proudly wear another’s weight
of paralytic dread.
So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:

“Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.
Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:

There is a balm in Gilead 
To make the wounded whole; 
There is a balm in Gilead 
To heal the sin-sick soul. 

Some times I feel discouraged, 
And think my work’s in vain, 
But then the Holy Spirit 
Revives my soul again. 

If you can’t preach like Peter, 
If you can’t pray like Paul, 
Just tell the love of Jesus, 
And say He died for all.”

Ventricular fibrillation (perhaps torsades de pointes?) and then SHOCK resulting in ROSC. The only successful shock on a long night of ICU call.
Rhythm monitor strip; can you guess what it is?
Leave It There