Vigil, chapter 1

3:00 AM, Minneapolis VA

The character and tone of my reports are going to take a sharp turn, at least for awhile.

I’m alone with my step-father, Ed. On deathwatch. I suppose “vigil” would be a gentler term, but I’m not feeling like pulling punches just now, and since I have no editor (this is a blog, after all) let’s say it is what it is.

The plane from Portland descended into a sad, gray Twin Cities twilight, and by the time the train from the airport left me standing on the VA station platform, it was dark, windy and cold, making the short walk to the hospital seem dramatically longer than it actually was. I sent mom and her sister Rose off to check into a hotel for the night; mom needed a break, and a chance to (try to, anyway) sleep in a real bed, instead of the lounge chair she’s been dozing off and on in for the last several nights. So now it’s just me and Ed, and the night shift nurses. Emotionally surreal, but oddly, professionally, familiar; am I the dutiful son, or the R.N.? This sensory landscape is way too familiar; the lighting, the sounds, the machinery. And the breathing. The gasping, halting breath to which we’ve mis-assigned the Latin name “agonal” respiration; gasp-in-and-out- full stop, pause, then another gasp-in-out, stop, another, stop, another, stop… the brain stem’s auto pilot, hardwired for one thing and one thing only; keep breathing, keep breathing, keep breathing. It’s the morphine, Morpheus descending, coming for to carry him home. Morphine blocks the pain. Without it, sheer, protracted agony as the runaway train of cancer cells tears through the lungs, the liver, through everything. Morphine keeps that pain away, but also depresses respiration. Morpheus lulls even the autopilot; they are both very, very old gods, ancient enemies. The cancer will continue to grow, this sort, very fast. As it does, the morphine infusion rate will be increased, which will further depress respiration… It’s a finite equation, a triangulation race between pain, morphine, and breath.

Not surprisingly I suppose, I slept only fitfully last night. And dreamt, vividly, almost violently, about working in hospital, as an R.N. It’s been 25 years since I set foot professionally in a hospital, and I can’t remember when I last had a nursing dream. But last night I did; it was not a sweet dream. I was just suddenly there, on unit 10-A in St. Mary’s Hospital, understaffed of course, patients coming and going on gurneys, falling out of bed, ringing call signals, nurses –some of whom I recognized, even as they appeared, aged naturally by decades- were rushing all around me with med carts, bedding, food trays, medical machinery of all sorts- and I could do nothing. I didn’t know any of the patient’s names, or which were assigned to my care. I couldn’t read; the medication and procedure schedules were just a garbled mess of meaningless numbers and letters to me. I didn’t know where any of the supplies were kept, and I couldn’t seem to actually put my hands on anything, pick anything up. I tried to ask for help, tried to warn the other nurses that I was lost and useless, but my words were weirdly silent in the din of the unit, and they all seemed totally unaware of me. But not the patients; they reached out to me, spoke to me, asked for my help. But I couldn’t help. I tried to, but somehow, I couldn’t touch them either, any more than I could pick up a towel or cup. Even to them, I was a ghost, a helpless, panicky, anguished ghost. It seems to me that more than once, I surfaced from this dream into an awareness that I was in bed, dreaming, but each time I drifted back down into the same dream, like drowning, until finally it was morning, and I awoke for good, shaken, the emotional residue of the dream draining from my consciousness more slowly than the dream itself.

The nurses will come in to turn Ed in bed every couple of hours. When people sleep, even in “a good night’s sleep” they move around a lot. “Toss and turn”. This is natural and healthy; if we didn’t, the pressure on particular spots on the body –the hips, the shoulders, the heels- would restrict circulation to the point of starving those pressure points to death, resulting, eventually, in pressure ulcers. Bedsores. I’ve treated tunneling pressure ulcers deep enough to completely bury three or four golf balls. So we move while we sleep. But Ed’s not sleeping. He’s not awake, but sleep is not where he is. He won’t turn naturally on his own anymore, so nurses will turn him; from his back, to his right side, to his back... When they turn him onto his left side, the weight of his right lung –and whatever else is in there- will rest on his heart, a heart already stressed from trying to supply sufficient oxygen to the body without a sufficient supply coming from his compromised breathing. Compromised by the morphine. The morphine necessary to keep the pain away.

Welcome to hospice.

I always think of Ed first as an artist; a painter, a pianist, a sculptor. Collage-ist? Drawer? Anyway, whatever the proper name, though Ed worked in a diverse variety of media, it was always just that; a medium through which he expressed his creative ideas, his intuitions, and especially, in Ed’s case, his passions. Like any good artist Ed very much appreciated the quality of things; pigments and gels, wood grain and stains, tone and timbre, but it is ultimately passion that animates Ed’s work, because passions are ultimately what animated him.  Ed was also a scholar, an intellectual who read voraciously, deeply, and widely.  As a young man Ed devoted himself for a time to the seminary, and his relationship to his faith and the church remained an animating passion to the end.  Ed devoted himself to serving his country in the most direct and selfless way possible; he did three tours of duty in Viet-Nam, on the ground, as a United States Marine, serving as a surgical technician in forward based field hospitals, discharging his duty not only with honor and distinction, but with enduring compassion for those most in need the of the tender, skilled attention he bestowed with such incredible grace and strength.  His duty the military thus discharged, Ed then devoted himself to teaching art in the public schools, which -trust me- sometimes makes combat duty look like a walk in the park.  And ultimately, Ed devoted himself to my family.  Point here is, Ed has taken on and grappled with a greater swath of what the world offers than most people I know, and through all the struggles and doubts (and they are legion, for Ed was also a restless soul, haunted by doubt and unwilling to accept mediocrity) as well as the satisfactions and rewards, the constant throughout has been that he really, genuinely cares. I’ve never known Ed to ironically slouch around an idea; if it matters, then by god, it matters. And this quality not only allows Ed to engage his art with a rare sort of guileless honesty, but also makes him, in my opinion, a great teacher. Which is in fact how I first encountered Ed; as my high school art teacher. Now in the interest of full disclosure I have to say that while Ed was the Art teacher in my high school, he was not actually my teacher, until much later. As a result of my own peculiar neuroses, I gravitated into the orbit of the Music/Theatre/Social Studies crowd, and never really got to know Ed when I was in high school. But I was aware enough to know this; that Ed's students adored him, and that those adoring students included some of the meanest, most incorrigible kids in the district. He was getting through, not only to the more or less obedient kids who were always expected to “do just fine” and did, but he was also getting through to kids who had made a public stand against giving a damn about anything, especially anything a teacher had to offer.  But they got turned on –hard and bright- to art, because Ed was able to show them how to tap their own innate passions and talents, always there but buried under heaps of small-minded ignorance and low expectations so sadly typical of small town rural America.  It surprised everyone, most especially, those lost souls. Ed changed their lives, and even through the teen-age fog of my own self-absorbtion, I could see that.  And I respected that.  But is was years later, after he an my mother married (my own father passed away before Ed arrived to take up his teaching post in my home town) that I finally got to really know Ed, who never treated me with anything but tenderness and genuine respect- even when I didn’t deserve it.  He became an unflagging supporter of my own ventures into, as the great American poet and songwriter Greg Brown named it, “the poet game”; the restless, never-ending search for truth, beauty and meaning beneath the surface of the everyday everyday. We talked art. We talked religion, we talked philosophy and food- and his passion was contagious, in the very best way imaginable.  Ed was a good man, at once strong and gentle, who did, finally, with never so much as a whisper of his far, far deeper life experience, become one of my most cherished teachers.  And I, incorrigible as any, as ever, came to love him.  I will miss him so much.  I hope, somehow, he knows this.

And now I’ll stay with him. So he won’t be alone. So mom can rest a bit. And be mindful of my own slow, deep breath.