It was only moments ago that I saw him. Having tightly bundled the baby girl I was taking care of so she could get some uninterrupted sleep, I ventured out into the hallway to see if anyone needed help. I was in an area of the intensive care unit where there were a series of single rooms, mainly used for isolation. I stuck my head into Janet’s room. I could barely see her through the web of wires and tubes.
"Hey Janet, can I do anything for you?"
"Rachel! Am I glad to see you. It's hectic in here tonight." I stepped into the room amd she continued, "If you could make me a up a new dopamine infusion that would be great. His is running low so we should probably have a fresh one going for transport. Maybe after that I’ll need a hand putting a new blue pad under him.”
"No problem", I told her.
While Janet finished drawing blood work from the arterial line I rounded up the supplies I would need to make up the syringe. Washing my hands I looked around the room, my eyes resting at the bedside. I could see a head of blond curls and that smooth,‘I just came back from Florida’-tanned skin. I scanned the monitor that hung heavy from the ceiling. Clearing off a space for myself on the counter, I picked up a clear plastic bag to move it. It contained a small pair of worn flannel pajamas with pictures of trains and clouds in faded primary colors. I paused a moment, still holding the bag, and then turned back toward the bed, straining to take a better look. Recognition flooded in.
“Hey, I know you,” I said softly, smiling, walking toward the bed. “Michael!" I confirmed it was him, reading the name tag at the end of his bed. "Hey little man, I know you like us a lot but you didn’t need to come back to visit so soon!”. In fact, I never expected to see this kid again. His was a happy ending. He was born with a cardiac defect, one of those congenital conditions that often require a couple of stages of surgical repair. I took care of him at the time when he was recovering from his final operation. I remember how his Mom and Dad were exhausted and anxious, but they knew it was his last and that it had gone well. I wondered what he was doing back.
I could see that Janet had stopped what she was doing and was looking up at me. I continued,
“You look like you just spent the last two weeks building sandcastles.” I looked towards Janet as I said, “Check out these tan lines!” The last two words trailed off as I saw her expression.
Now, alone in this tiny space, I hug my knees to my chest and I draw my sweatshirt over the bridge of my nose, filling my lungs. I’m only vaguely aware of the smell of laundry detergent and antiseptic. The walls surrounding me are painted a comfortable bland color that's hard to name – some version of pale yellow or cream. In the safety of the bathroom, I recall the expression on Janet’s face, but then I will my thoughts away from this place.
My mind wanders back to the time I worked in a psychiatric ward as a nursing student. I led a weekly art group on a lock-down unit with people who were acutely psychotic. I think it's the pale yellow walls of the bathroom that remind me of the promise of those pristine pieces of paper that I would hand out to the group. I can almost smell the oily scent of the pastels as if I had just opened the package. I used to put all of the supplies on the table before we began, and it was that moment, right before anyone picked up their first pencil, that felt so full of promise. I think that if I could, that would be the point where I would have it all stop moving.
I recall one session where Floyd, a young guy who never said much, stared blankly at his page, which wasn’t unusual for him. After a long time, he picked up a paintbrush, dipped it into a Styrofoam cup of water and then circled it around one of the colored pucks of paint. He filled the brush to saturation and then held it over his paper. I could barely breath waiting to see what would happen next. Just before it dripped onto the page, he stuck the brush back into the cup. The cloud of pigment spread through the water like a silent detonation.
“Hey, what the hell? You can’t do that! He just screwed up the whole cup of water!", Jason, a new group member yelled out. He turned to me, "Now his colors are gonna ruin mine!.”
I could see that Jason was the kind of guy who was ready to jump on anyone he took as a threat. He had been admitted the night before after an altercation in a convenience store. He was convinced that the guy behind the counter had only denied selling him a slice of pizza because the ‘government wanted to cut off his food supply at the source’. During rounds that morning the psychiatrist that presented the case told us that this convenience store didn’t even sell pizza.
I introduced myself to Jason shortly after rounds, and I invited him to join the group. He had eagerly come to the table and before I finished setting up he had the whole group enthralled in his tales.
“…so what I do is I pop a bunch of Tylenol in my mouth and start chewing them'n shit. You know how they taste so bitter, right?” He continued before he received any response. “Then I can feel my stomach getting all acidy and it makes me mad." He leaned back in his chair smiling. "That’s when I know I can take on anyone.”
I found myself among the group who was captivated. Oddly, I think a small part of me envied how he chose to heighten rather than suppress his reaction. I refocused my attention and picked up an orange pastel, trying to set an example for the rest of the group. I took one last look at the unmarked page and started my first smooth petal. I chose a brilliant turquoise-blue for contrast. Glancing up I saw that everyone had picked up a pencil or pastel, except for Floyd.
I'm not sure what made me think of the art group. I picture Janet’s face, the look that forced my smile to lose it's content and my sentence to fade.
“Rachel, he’s dead,” she'd told me. Then, in response to the confusion on my face, but not before a dramatic pause that made me hate her, she continued. “Bathtub accident. They’ll be taking him into the O.R. soon. There will be some families getting quite an Easter present this year, as long as his organs look ok when they open him up”.
Sickness, horror, and rage carved through me leaving me hollow. Somehow I managed to keep nodding, feigning calm professional curiosity as Janet forged ahead with the brutal details. Nothing irritates the seasoned ICU nurse more than the very human reactions they work so hard to bury. When I knew I couldn’t manage another clean nod I withdrew, heading directly for the bathroom.
I press my palms into my temples, trying to push away the ache. My hands slide upward and my fingers meet, interlocking at the top of my head. Like this I stare up at the ceiling, my thoughts returning to the art group. I remember that day, how people were finishing up their pictures and were at different stages of displaying their work. Some folded little pieces of scotch tape into squares for the back of their artwork, others searched for a good spot on the wall for display. I reached for the white pastel and blended the orange into the blue on each petal. Once I had created a smooth uninterrupted flow of color, I picked up the black pastel. With smooth deliberate movements I enclosed my flower in a thick, black outline. Satisfied, I reached over to return the pastel when I saw a heavy brown hand reaching for the same package. Looking up, I was surprised to see that the hand belonged to Floyd. I remember thinking how strange for such a big guy that he was wearing one of those candy watches, which eternally read 3:00. The candy beads that used to be there had all been chewed off, leaving only a thin white elastic band that was too tight for his wrist. I thought how if I had noticed the watch at the beginning of the session the time would have been dead-on. He withdrew his hand and I saw that he had drawn something on his paper. It was small and difficult to make out. Trying to hide my enthusiasm I asked him what it was.
“It’s me, driving a car”.
“I see some pink in there. Is it a pink car?” I asked.
“Yeah,” he answered. I was sure that I could see the beginning of a proud smile. “It’s a Ca-dil-lac.” He emphasized each syllable with a slight side-to-side movement of his head. “That’s the car I’m gonna get someday”.
I hadn't realized I was smiling until I felt it wilt. I was overcome by a sudden sadness and I wished he had just left the sheet blank like he did every other time.
Hospital wide alarm bells jolt me back to the present. “Code blue 6 D-Delta, Code blue, 6 D-Delta”.
Thankful not to be on 6D, I wash my hands one last time, hesitating a little longer at the sink. I stared into my own eyes in the mirror, imploring the hot water to penetrate my skin and warm the blood returning to my heart. I walk down the long colorless corridor, finding myself back in Michael’s room. I hear myself rambling to Janet about how ‘weird the situation is’, and how ‘at least something good can come from such a horrible tragedy’. Janet carefully lifts him an inch off the bed. I slide a fresh blue pad underneath him. I remove the stethoscope from around my neck and I listen to his breath sounds and heart sounds. I note the vitals on the monitor. I feel both of his small feet for pulses and check his perfusion. He’s warm and his color is good and I pretend that I don’t know it’s only because of the machines and the medication. He looks like he’s sleeping. It reminds me of when I was in university and I would often go on roadtrips with my boyfriend. Whenever I saw an animal, dead on the side of the road, I would get upset. My boyfriend would comfort me, his hand pressed against mine, telling me, "It's ok, it's just sleeping."
The OR team file into the room to get handover for transfer. Setting up the transport equipment I try to figure out how, logistically, all of this actually ends, because as much as I understand the process, I can’t get my head around the last bit - when Michael ceases to be in this world. I mean, I know that the point has, by medical definition, been reached, but I keep trying to imagine the order of things. Will they extract them one organ at a time, starting with the least important or will they take them all at once? The uncertainty of the situation adds to the discomfort and somehow I think if I could just nail it down to the moment it would somehow be all right.
More people have filed into the room. The respiratory therapist removes Michael from the ventilator and manually bags air into his chest. I think how those little ribs will soon stop moving up and down. Someone releases the breaks on the bed with a loud metal clang and I jump, heart pounding. I scan the faces in the room to see if anyone noticed. The chaos of activity soon streams into a fluid mass exodus. I follow them out into the hall. As Janet walks passed me on her way back into the room she looks at me, shakes her head and sighs. I know this is one of those looks ICU nurses give each other that demands a reciprocal response, but instead I turn and watch the slow mass of people and machines. I focus in on the head of blond curls as they move down the hall and then dissappear.