Wednesday, October 1, 2008

Allowing a Connection

"I'm dying.", he said. " And I don't want to."
I had to stop. I couldn't not stop. I could hear the tears in his voice.
Here's the thing: I try not to feel while I am at work. I know to the average layperson, this will seem terrible. Because I wear the badge of "healthcare professional", I am supposed to be this all-feeling, caring, compassionate individual. To a degree, I am. But I am also human. On a daily basis, actually multiple times per day, I see patients as they face death. I cannot allow myself to feel. If I did, it would be my downfall. So when I am at work, it is all science. In other words, let me help you physically overcome your disease. If the disease is going to win, I will at least go down swinging for you. I win the fight many, many times. But I lose, also. And then I have to go home to my family, intact, and play the role of Mommy.
There are some situations where I cannot turn it off. Well, I can almost always turn it off. It is just that sometimes, after I have turned myself off to what is happening, the emotions of it all catch up with me later on, when all is calm. The first time I had to resuscitate a baby, John knew immediately that something profound had happened to me at work. I walked in the front door, enveloped Evan in my arms, and automatically started to cry. But while I am at work, I cannot allow myself to shut down. I am a professional.
So here I am with my patient. And he is dying. I have just finished giving his bronchodilator treatment. I've replaced his oxygen cannula, and have turned to leave his room in the intensive care unit when I hear those tears in his voice. He has end-stage COPD. Not only does he have to face the fact that he is dying, but he is doing so with the full realization that his actions caused the condition. He is ashamed. He is sad. He is guilty. But mostly, I hear fear: fear for himself, fear for the loved ones he will leave behind. And in his voice, I also hear my mother. You see, we never truly get over the loss of a mother. Never. Enough time has passed for me since my mother's passing that I can carry on with my life without you ever knowing that she died. But she died of COPD. And I became a respiratory therapist. My ability to disconnect keeps me safe from ripping open the wounds.
For the first time since I was a child, losing her mother, I am powerless with this patient. I cannot stop what is happening to him. I can intubate and place him on machines that will keep him alive, but I cannot grant him the ability to truly live. I've seen the chest films. I've looked through his chart. And I know that nothing I can do will help him. So as his wife sleeps peacefully in the corner of the room, I sit with him. I hold his hand, and we cry together as I tell him about my mother and he tells me about his wife. To him, I am the other side. I am the one left to live, and he is the one afraid to leave. I tell him the truth. I miss her every day, but the degree to which I do became less and less debilitating each day. I explain how I reached the point where I can see the influence she has had on my life, shaping me into the person I am. How I can see her in my son's smile, even though the two of them never met. I tell him how she lives on inside of me.
My day finishes. I am no longer on hospital time, but rather my own. I hold his hand as he drifts off to sleep. He seems more at peace, somehow less afraid. But later on, in my home, as I close my eyes to try to sleep off the night I had, all I can see is my mother's face. Swimming in my tears I never shed.

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