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

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