Code/Letting Go

I’m having trouble in my meditation practice this morning. I count breaths. Then heartbeats. At first, it’s all a bit wild, like someone signaling madly to be held quiet, an intense desire for the even intervals, the cloudless mind. I know that meditation can reduce stress in the heart and in the universe. It makes a path toward the light in a dusk-driven world, a release from nightmare, a way to locate the chaotic mind and unfasten what is tying attention in knots. Detach. Breathe out farther than you breathe in. Empty. I try to recall the shape the old man in my home village told us to hold our bodies in when we brought an ailment to him. The chant I remember sings lower than a human ear’s capacity to perceive. I remember the flavor of healing.

I work in a mid-sized urban hospital, staffed by nurses, doctors, technicians, clerks, housekeepers from every part of the world. I am one of almost 4000 employees, who care for about 350 patients on any given day. We speak every language. We own every skill we need to care for our patients. We come from the Philippines, from China, from Nigeria, from Puerto Rico, Cuba, and Haiti, from Eritrea and Ethiopia, from India and Pakistan, from the West Indies, from Mexico, from Peru and El Salvador. Many of us who were doctors in our home countries work as nurses or medical technicians here. We work beside others whose families have lived for generations in the United States.

What keeps me from my meditative state right now is how our 79-year old patient in the room at the end of the hall hangs on after multiple surgeries. Unshaven, breathing roughly, still pleasant when we awaken him to take pills. During the first few days, the man reads the newspaper after breakfast, before dozing off for a nap. He offers his arm for the blood pressure cuff. He knows the drill. Then he drifts off again. He hangs on to a life that filled him. As a child, he played one day on a windy beach at Coney Island. He went away to school in the crowd and blather of Boston, where his mind filled with numbers and shapes, one formula and another. He learned how to see, and how to measure what he saw. This is how he grew into the skills of science. The lab bench was a second home to him. A slow and then a quick comprehension of relations between particles led him deep into new molecules, never dreamed, never photographed, before he held the newest instruments of discovery and found it all, waiting for him. Then one day at his bench it dawns on him: a sweet sensation of how the nerves feed one another —how they signal— and he has the instruments to prove it, and the skill. Congratulations, prizes, teaching. Then that other discovery. First she edits his term papers, then she hears his fears and confessions, then she likes him better each day, then she moves in with him, for good. All this brings him friendships and colleagues who, later, know how to sit with him in the summer heat and watch the children play.

How did his children grow into their own lives? They did. His wife still edits and teaches and loves her work. When she dies on him, he is bereft. Soon, he retires from the work that could have consumed him and flies west to be near his daughter. His mind follows every nuance, and his body keeps up with his agile mind for most of those years. Now is the hard part, winding down. And illness. Unprepared for. And treatment: Sharp knives, skillful stitches, collegial surgeons trying to make torn parts whole.

His daughter, herself a scientist at the nearby university, comes in to visit most mornings before the day shift begins. The nurse keeps the room clean and quiet. Plastic cup, a safety razor, barely capable of scraping away the three-day growth that, for the first time since 1968, clings there on his chin and cheeks. The daughter’s children visit their grandfather each day after school, about the time the evening shift gets under way. They crowd noisily into his hospital room, and talk with him about their day, about the news at home, and the news in the world. While they’re there, they make themselves at home. The nurse is the visitor. These are signs of health. Signs that can sway the reading of prognosis.

Then, the old man, our patient, left alone in his bed for a moment in the early evening, tries to die. A sharp, side sweep of breath, and then again, a single breath, this place pounding inside his chest beneath the breath. His heart stops. His breath comes to a halt. No one is watching when he chokes softly, mildly, and, definitively, stops breathing. It is a simple choking. Over the past few days, few weeks, few months, he had lost the strength to clear his own throat. Had he been at home, he would have died in his sleep. It was time for him to go. We could have let him go when he said, softly, too softly for us to hear from the hallway, “Ahem, time for me to go.” But, since he is in our care, and he has signed no formal paper forbidding us, we have no choice. When a choice was still possible, he and his family were, naturally, thinking of other things: of life, of getting through this crisis together, of recovery.

His nurse is obliged, by law and protocol, to walk into his room every 15 minutes, to count his pulse, his breaths. This time, she finds him, cold, and calm, crashed against the white sheets. She calls out, rattled, for someone at the desk to call a Code Blue. The alarm sounds. They come, the code team. Machines roll into the room, dragging the personnel behind them. People who had risen from their beds that morning, counted their children, prepared breakfast for them, and sent them off to school, before changing into their own necessary reflexes. Off to work they went, full of purpose, ready to help other people’s children sleep easier. Once in the room, these team members plug the machinery firmly into the wall, a temporary source of electrical impulse necessary to keep the energy and materials flowing through the patient who is temporarily absent, the rivers in him tentatively still. They pull the clammy skin of bright-colored imitation latex gloves hastily over the real skin of their hands, which are scrubbed dry and brittle, cracking open at times.

The patient has no choice either, by this time. Once there, with their gloves and spikes and masks, the team members engage the reflexes acquired in their training. They set upon him. Someone’s fist slams into his motionless chest. They lay the paddles on the skin above his heart, step back, and his artificially electrified body leaps toward the ceiling. The men and women gather around him. After laying him flat, they prod him open. His tongue, which he had used to shape his voice, they shove roughly out of their way. They extend his throat, which he had used, in other times, to call out. They thrust some foreign stainless metal downward, toward those sweet wet bellows he had used to gather air, to sing, to sigh with pleasure, the wind already drying the air he needs now. A too-long, hollow needle forces into him dense measures of the molecules his body is declining to produce for itself. They start him up again, beat his heart, breathe his breath. An erratic, almost inaudible pulse and breath skim the air of the room. Team members gasp in time to their patient’s raging ragged pulse, displayed, outside his chest, where they can see what’s left of him, up on the screen, jagged. They all know the beat is too rapid, too shallow, too irregular to sustain a flow of what’s necessary to hold the pulse inside him. He would know this, too, if he could see. Their eyes veer from over the sickly green face masks, toward the screen from moment to moment to see his life outside his battered form. Their masks hide the lower part of their faces, hide the grimace, while they avoid each other’s eyes. Once or twice, they obtain what they call, technically speaking, a normal heart beat. Too fast, but an even pulse, originating inside his broken chest. Once again, he almost lets go. And doesn’t. Can’t. Doesn’t have the strength to let go. The beat is thin, but present. The code is over. They stop. No time of death is logged, this time, because the old man has failed to die.

They had beaten his heart almost to death. They leave him empty. Some walk away, slowly, shake their heads. Still vibrating. That contagious buzz. Trembling, shuddering, together. Three of them, almost leaning against each other now, roll him away, toward a smaller room, more wires to hold him down, where his new nurse will watch the rhythm. A machine huffing alongside on its own wheels.

Once the chart of the old man’s code is accurate, with check marks in the correct places, and signed, his old nurse —she’s young, but feeling very old right now— the one who walked coolly into his room forty minutes ago, staggers back to the long narrow desk jammed up against the wall at the nurses’ station. She uses her feeble voice to thank her colleagues, the other nurses who watched over her other patients while she’d overseen the last moments of what the man’s family will call his life. Then she moves back into those other rooms, to apologize to her other patients for her lengthy absence. The shift is almost over. We finish, with fewer words than most evenings. Some of us skip our dinner break. The missing patient’s room is cleared and cleaned, the trash, the bloody paper and tubes, needles. Everything is late. No one speaks of what happened. The remainder of the shift is torn apart, litters the floor, sours the air we breathe.

For the next few hours, the old man’s nurse, who comes from a village half a world from mine, goes about her work, empty-eyed. She has a long night in front of her, after an evening interrupted by great suffering. She will take this home with her. It will not let her sleep. She takes a deep breath, and sits down to chart the details.

*****
Most of the doctors and nurses and technicians who took part in this code are immigrants. We have come mostly from cultures that are not so enthralled to high technology, or, perhaps more accurately, we have a different relationship to it. But we are the ones who apply the machinery to our patients every day. There is no debriefing after dramatic events, or even after trivial ones. There is no time. We take what we have done home with us, at the end of our shifts.

When we left our countries, we knew what we were bringing with us. Our training as nurses, of course. Plus language, food, our children, our parents, ways of teaching our children their place, by feeding them, for example, by the order of feeding, who eats after grandfather, who before grandmother, who eats. Who gets the last word in how to discipline the children. How to die as much as how to live.

Our own children are embarrassed by our accents. They gobble hot dogs when they are with their friends and, secretly, on special days, relish our mothers’ holiday foods, the texture of sweet, the color of pungent, the sting of sour, the air we used to breathe, how fast, how deep, the melting of the tongue when salt touches the edge of it.

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