Walking into a night shift, you just never know. Most of my day shifts have a predictable rhythm to some degree, but admitting at night can be sheer madness or sleepy boredom or anything in between.
“Hey, glad to see you, so let me tell you about this lady in Bay 2…”
She had coded multiple times, and actually had time of death called at one point, but then regained pulses. Not brainstem reflexes, no hope of neurological recovery…but again with pulses, because modern medicine is extremely, brutally effective.
And now she was mine. Mine whose vital lies I was asked to preserve at the family’s insistence, mine to maintain on whirring machines, mine to push chemicals into, mine whose marbled veins into which I was to waste precious donated liquid flesh trying to keep her tattered heart beating that beautiful gift-blood to a brain that had already stopped functioning, to kidneys that hadn’t worked well for many years, to a liver that was oozing her own acidic blood because it had been torn open while her ribs were being broken during chest compressions…mine to “help,” mine to “save.”
And while I worked to brutalize what remained of her, the admissions kept coming. Two little old men with half-functioning brains, with different infected bits causing what little mind they each had left to flutter off, leaving me to guess at their histories as their tired families shuffled off into the night, maybe just tonight, maybe forever, maybe done. I tried to make stories from med lists. I tried to extract hopes and fears from what remained of these partial people, these small suffering remnants in front of me. I tried to be more respectful than my profession had been to them previously, but it was hard, because I was simultaneously trying to maintain the vital lies in Bay 2.
Another admission, still a whole body, most of a whole mind, but a world of pain. I am just a person and I don’t have a crystal ball but I know about crystal meth. I see the path in front of this man who can only look backwards. I was asked to fix his numbers too, just his numbers, but he is still a whole person and so he can still tell me what’s wrong, and nobody was listening because all they could hear were habits, but he was really so clear, it was like he was singing verse I already knew and his songbook was a textbook and the tired instrument of my mind which has been made to see red for so many years did what it has been programmed to do. The hammer hit my brain and the reflex was intact: I ordered a noncon head CT. STAT.
And then back to those vital lies, but the truth set her free. The truth that she was gone, that she was done, finally trumped our chemical and electrical engineering. Three more rounds of ACLS, but nobody’s heart was in it, most of all hers.
The CT was read as normal by a person whose only job is to be right about that, and I wanted to believe it because I had so much writing to do, because I had been working so hard all night to push giants into different orbits and I had to show my work, so that the man who parks his Tesla closest to the door can have his arithmetic work out, so that the lawyers have no empty space in which to play with our lives. But I knew it wasn’t normal, because my instrument had processed the textbook-song, he had read the script aloud to me and I knew the ending. So I doubted and I looked, and there was a smear of bright white like a comet across his frontal lobe, and I wondered for the 48th time in my brief career, “what the actual fuck do we pay radiologists for?”
I may have helped him, my only victory of the night, but only with this one small battle. We won’t win the war. I still don’t have a crystal ball, but I remember crystal meth. I may not understand what an ode is, but I understand amphetamine. I know it is a brutal force upon a soft body just trying to survive in a world of pain.
At some point during the night I cried in a bathroom, but my heart wasn’t in it.
I called a daughter and told her that the terrible truth had won.
I left, squinting at the sun, still in its orbit.
