After a Year Absence

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thoughts on might. 29 Jan 2006

thoughts on first assist

Fascinating, brilliant, intriguing, absorbing, mesmerizing…and stark. I couldn’t shake the feeling of bare and silent aloneness that accompanied the excitement of acting as “first assist” to the surgeon during a cesarean section the other night. The doctor generously invited me to stand opposite him at the operating table in the usual place of the assisting physician. The true first assist stood to my left, watching over my shoulder as I followed the surgeon’s instructions. “Hold the clamp here; with your other hand you can direct the suction…you can see the fascia here, now separate it with your fingers, as I’m doing…good…”

As the mind is apt to do, mine applied known experiences to each new one here, as a way of comprehending what was happening—what was happening by my own hand. I thus found the procedure to be quite logical, sensible, and predictable, yet all the time just beyond the grasp of anything I’ve ever done. I was grateful for the opportunity and quite thankful that I would at least be familiar with the role in the occasion of an emergency.

Yet no matter what effort I gave to becoming completely absorbed in the work of our hands, I longed to be on the other side of the curtain, where I could see the soon-to-be mother’s anxious face, perhaps put a warm hand on her arm as she moaned in discomfort with the pressure and movement, assure her that everything would be alright and that her baby boy would very soon be hers in this world.

But soon the final incision was made into the uterus, the baby maneuvered to the opening, and brought into the bright sterile room. I marveled—as always—and jealously watched the medical technician and pediatrician take him in a white towel and place him on the warmer. I turned my attention back to the surgical site to the delivered placenta, which had an interesting anomaly, and then to the uterus, which had been pulled from its place inside the body and placed on her abdomen. I massaged it as I wrapped it in wet gauze and felt the strength of this living organ in my grasp, natural contractions clamping down to prevent bleeding. Then began the process of sewing things back together. I held the suture taut as the surgeon drew the edges together, and I was captivated by the utility of the process. After the last stitch, I headed back to the unit to prepare to receive the mom from the operating room. I had a feeling of surprise and interest, yet still that strange echo of disconnection. Back in my groove, I had the room ready when they wheeled her back and was strangely relieved to be able to smile at her, touch her arm, and reassure her that everything had gone as planned and her healthy baby boy would be in the room in a few minutes. I really do love my job. But I guess more than that—as trite as it may sound—I really love the people. I should not forget that.

Currently Watching Wit see related

26 Oct 05

On the airplane back to Mississippi from Vancouver, BC.

Sitting behind two little girls from London who are both chanting “Oi, oi, oi,” in a very musical tone. Liv shoved her vinyl pink purse with all the Disney princesses on it through the crack in the seat. She pointed out each one by name. Inside is the Jack of Diamonds and a yellow post-it note upon which she has written her name in skinny block letters and her friend’s name, Ben, all written backwards.

“He lives in London, where I live.”

That’s a long way! When will you see him next?

“Umm…in fifty minutes.” Then, “This is my sister. Her name’s Maya.” Maya peers around the seat at me. Her blond hair is long and silky. Now they’re each playing "Sponge Bob in Disney World" on their game boys.

“A game boy is a small computer. Yours is a large computer," Liv states triumphantly. Mummy’s now telling them to sit quietly. I didn’t mind them at all…but I was going to start writing about the Gulf Coast after Hurricane Katrina. I find that the farther away from it I am, the less I want to remember it. But very soon I’ll be away from the Coast that I grew to like in some ways, and I’ll wish I had written down all the thoughts I only later was able to think about.

K+1, first day after Katrina

Time suddenly sped up after my first glance out an open window of the post-hurricane sight around the Air Force base's Medical Center. My nurse manager, a Major, found me and said she needed one more nurse to volunteer to stay in the hospital. I figured we’d all stick around to get the patients air-evacuated, and then she needed a few nurses to stay on the unit for the next few days. I thought of how badly I still hoped to go on leave to see my fiancé and his family in Wisconsin. Surely we’d be released from the base by Thursday, and there wouldn’t be any patients to take care of. I’d go to Wisconsin for a week and take care of insurance claims from there or call around for a new apartment or car shop or whatever awaited me depending on the amount of damage. I nearly dismissed the idea as severely misplaced optimism, but I couldn’t help but wonder about the possibility. I began to ask the Major if I could give her an answer this afternoon, but she said she needed an answer now. I said I did not want to volunteer to stay.

By late afternoon hospital staff were escorted a few at a time to check on their cars in the parking lots. One of the nurse anesthetists walked me out to mine and explained that they just didn’t want anyone driving away from base; the General had information that there was looting just outside the gates, and some looters were armed and less-than-logical. We rounded the hospital’s west end to the parking lot where my car had ridden out the storm. As I got closer I kept telling myself that SOMETHING on the car must be broken. I walked around the car at least five times trying to find anything wrong with it. Not a new dent or scratch. No mud shoved into the exhaust pipe, no branches wedged underneath it. Water. Surely inside would be soaked, and I worried that the remote access wouldn’t work and the alarm system would go all crazy when I opened the door. I’ve never been able to figure out the alarm system and am always afraid it’ll go off and I won’t be able to stop it. But it opened normally, and the seats were dry. The papers on the floor were dry, too, and no matter how hard I pressed my hand into the floor, I couldn’t feel anything wet. Okay, so the car’s water tight. But what about the engine? I opened the hood and looked over everything, but no puddles of water in any space. Everything looked just as it should. The car started beautifully, and even the air conditioner, which I’d left on, blew out cool air. I crawled around the whole car on my hands and knees waiting for some foul liquid to leak out while the car ran. I stuck my nose right in the exhaust pipe, and it smelled like a healthy car. I’m sure no one needed to read about how normal my car is, but you’ll never understand just how astounding it was unless you saw the few hundred cars parked in the south lot, all of them flooded at least to the seats, many with trees cleanly fallen through the roofs, windows blasted out by blown debris, or tires flattened. Some sat with doors or hoods gaping open as if the car had been in the middle of some sort of mechanical testing when the robots turned tail and fled. Later I found out I wasn’t even supposed to have been allowed to start my car: many people’s cars had burst into flames somehow when they started them, and other people had unknowingly cycled water through their engines, as the fuel gauge said full.

Well, that’s good, I thought. At least I can live in my car, because I’m sure my apartment’s shot. Walking back to the hospital I gazed at the spotless sky and breathed in the shockingly fresh air. I looked longingly toward the Gulf and wondered when I could feel the sand again. I had no idea that two months later the beach would still be blocked off by concrete barriers and uniformed men with weapons. But for now, I headed back toward the darkened, musty hospital. Cigarette smokers had new life in their eyes, huddled in a designated area just outside the entrance, sucking at smoldering sticks like they would bring salvation to their weary bodies. I was absolutely empathetic.

Inside the main lobby the security guards I knew looked slightly less familiar with sweaty, stubbled faces and stress etched on. They had been running all over the hospital keeping it secure. Once the day before they had been called to secure the stairwell when a man came to the nurse’s station having an asthma attack. Someone had lit a cigarette in the stairwell at the far end of the postpartum unit, where he’d been sheltering. One of the nurses grabbed the nearest doctor and got his quick approval to let the guy suck on her albuterol. I heard later that if they’d been able to find the smoker, that person would actually have been told to leave the base and find shelter elsewhere; lighting a cigarette in a hospital full of leaking gases and at the end of a hallway full of pregnant women was enough to make anyone’s blood boil. But the security guys were doing a great job.

My heart sank as I walked deeper into the blackness. The musty air was stronger than I thought, now that I’d gotten outside. I wound up the slippery stairwell again to the third floor. It was a flurry of activity. The staff who had decided not to stay were told to gather our things and get on the buses downstairs to be taken to one of the other base shelters. “What? The patients haven’t even been sent away yet.” Shelterees gave us funny looks as we appeared every bit to be getting out while they were staying put. I felt completely confused and guilty. We rushed around, but about forty minutes later were told we’d taken too long, and that the next bunch to go would be families who did not need to be air evac’d. Well, that’s better anyway, I thought. We helped people gather everything up and get downstairs, and as soon as the buses took them away, we were told to gather our things again and get in buses.

This time we did, and my bus drove to Allee Hall, one of the old training buildings across base. Most of the riders were staff from the obstetrics unit, including doctors, nurses, and medical technicians. We viewed an eerie scene of downed trees, cars at rakish angles, boats shoved into each other against the edges of parking lots, and pieces of homes strewn throughout yards and streets. A line of fresh young marines awaited us at Allee Hall and unloaded the bus in record time in bucket-brigade fashion. We shuffled into a hallway for check-in and upstairs to cleared-out classrooms, which would be our home for the next several days. After the chaos of the hospital, where everyone created their own methods and rules for stifling co-existence, the order of the shelter was a relief. I was glad to be told where to go and what to do next. I found a dark corner, where I unrolled my sleeping bag and blankets and set out to find a sink to shower in. I peeled off soaked scrub pants and a sticky black T-shirt and never enjoyed a cold splash more. I kept my head under the cold running water until an elderly German woman walked in. She looked mildly surprised and amused at first, and then asked me to help her open her green MRE (Meal, Ready to Eat) pouch of veal parmesan in sauce. “Tricky buggers, aren’t they!” we laughed as ugly orange sauce splattered the sink.

I walked back into the hallway and hadn’t even made it back upstairs when one of our O.B. docs enlisted me to help in the first aid station. I didn’t think a tank top, flip flops, and shorts fit the situation, so back upstairs and into another pair of scrubs and a T-shirt. Before I knew it I was laughing and joking with a Captain who is a hematology-oncology nurse who had been tasked along with a doctor to run the first aid station for this shelter. They’d been at it so far for 48 hours straight and were glad for some new faces. I liked the Captain immediately and welcomed the friendship.

Quickly I learned that the hospital had not housed all the pregnant women on base. The Captain smiled and said that some O.B. staff among them was a god-send. I hoped there was more smile than panic in my voice as I asked what in the world pregnant women were still doing in the shelter when all the ones in the hospital had already been cleared for air-evac and were supposed to leave in a few hours. Thus began the first of several supply and info runs back and forth between Allee Hall and the hospital. On the first trip over with the doctor, we scavenged medical supplies, baby formula, diapers, and medication from various floors, and I asked what the plan was for the rest of the base’s pregnant women. We loaded up my trusty, untouched Subaru, which even ended up serving as ambulance a few times later. Back at Allee Hall I began stopping women with big bellies in the hallway and asking them about their pregnancy—due date, any known complications, how they felt now, and if they had been having any contractions.

Two of the docs who had performed the C-section the day before were now with us in the shelter, and they monitored a woman who had been contracting throughout the hurricane. Eventually she took a ride over to the hospital, where they had the nerve to discuss the possibility of another C-section. I almost lost it then, but on another trip to the unit was told they were just watching her for now. That night the Major, who is a nurse midwife, and a neonatologist accompanied her by helicopter to a neighboring Air Force Base in Florida. But by the time they got over Mobile, Alabama, they knew the baby would be born in the chopper if they didn’t stop, so they landed in Mobile. They ended up hitching a ride back on a Coast Guard chopper, since every other mode of transportation out of Mobile was halted or destroyed.

Back at the first aid clinic in Allee Hall, the Captain and I chatted about anything and everything but the hurricane and finally fell asleep on cots in the first aid room after midnight. We were awakened a few times during the night by people who wanted cough medicine or some other thing, and then the morning started at about 7 a.m. with shelterees trickling in for supplies and medications. I was glad for the chance to keep busy and have some fun but wondered how long we would be shelter mates and when we would ever be allowed to go to our homes--or to whatever remained.

Currently Watching Since Otar Left see related

It’s the middle of October and I just finished reading a chapter in a book a pilot wrote about his chase across America for the ever-elusive glory. I was sitting on my balcony in a pleasant 82 degree shade, listening to the chimes chime lazily. I sipped grape Kool-Aid, or "Beverage Base Powder, Grape" as it’s labeled on the brown MRE (meal, ready to eat) pouch. The directions say to dissolve the contents in 12 ounces (1/2 canteen cup) of cold water, and to allow water just chemically purified to stand 30 minutes before adding it. Those instructions were fitting over a month and a half ago. I still have some humidity- and sweat-proof matches, instant coffee packets, mini Tabasco sauce bottles, and a olive-drab pouch of sloppy joe mix, all left over from meals in the hurricane shelter…that seems like such a long time ago…

After that cesarean section birth in the middle of Hurricane Katrina at the Air Force Base's dark, muggy, powerless hospital, I felt suddenly powerful and in my place. Strangely. I had a job to do, two precious people to take care of, something familiar. I busied myself with mother and baby care, and tried to busy Dad and their four-year-old daughter, too, but they were understandably shell-shocked. I let them sit, dozing, by the window in the bleak hospital room one floor down from all the action. A tired gray light bled into the room, and I moved a bedside table toward it. The paper in the patient’s chart sopped up more moist air than light as I scribbled my nurse’s notes. I had quite an eventful two hours-worth of information to recall and write for posterity, for the next nurse, or for the legal courts—whoever cared to know.

The four-year-old started getting restless and began an annoying ritual that ended up being repeated every five minutes every time I walked into the room; she had a certain determination to pull out all the folded up notes, the bag of medication, surgical mask, extra pen, and whatever else was in the back pocket of my scrubs. Once my patience wore thin, and while I was explaining something to Mom, I abruptly turned to the kid and said “NO!” Everyone looked surprised and I felt sorry and exhausted, but I didn’t apologize. I hoped next time Dad would lift an eyelid and tell her No himself.

The afternoon dragged on in a dismal, sweaty way that I cannot even describe. Mom became nauseous and itchy from the anesthesia. She begged for a different kind of pain medication because the red pill made her feel crazy or high. Back up a flight of stairs in absolute darkness—why did I lend out my flashlight?—to ask the doctor for a new order. Stumbled around in the nursery—didn’t know two families were staying in there. Grabbed some more formula bottles, a couple fresh baby t-shirts and blankets that were almost as damp as the ones on the poor infant, and the baby’s paperwork from the pediatricians. Then down a floor—I have GOT to find a flashlight. This is ridiculous!—to find a nurse to lend me the new pain medication from her stash. Back in the room my pocket friend—fiend?—went to work while I prayed the pain medication would work and changed the baby. All of us got our hopes up when we got word of an impending air evacuation; this family would be first on the list, and the C-130 should be here tomorrow morning, first thing. Soon it was time for change of shift. I made sure everyone was settled and went to find the night nurse. Before I’d finished telling her the details I was envisioning a sink shower and a glorious change of clothes. I handed off my treasure bag of medications, which were thankfully working, and wished her luck.

Next thing I knew the technician working with the nurse had run back upstairs and was calling out for cytotec and hemabate—Mom was hemorrhaging. A bunch of uncharacteristically expressive words went through my mind and may have escaped in a hurried whisper as I searched for every blood-quenching medication left in our drug room. Then I realized the last time I’d seen our only caplets of cytotec had been when I handed them off to the anesthesia provider to have on hand during the C-section. I gave the technician hemabate and methergine and sent her down while I went in search of the cytotec.

“Someone cleared out the room where we did the operation,” an Intensive Care Unit technician offered. Who’s Someone? “Try the operating room techs.” Down another floor—Forget it, I don’t even need a flashlight anymore; I know this place like a sewer rat should. Casual hellos and nods greeted me in the OR and hands waved to the bin they’d dumped everything into after the operation. When I mentioned the words “hurry” and “hemorrhage,” they jumped to my assistance. Found it, half-ran half-slipped up the stairs and down weeping halls with weeping floors to the room. The doctor was there and administered something that worked, and when things were quiet again (hey, no pickpocket this time!) I went back to the third floor and swore it’d be my last time in the stairwells for the night. I went to sleep with difficulty. An indescribably feeling of weary concern gnawed at the sides of my head as I wondered what I'd forgotten or could have done better that day. Of course, I often go to bed like that. I finally drifted off and didn't wake til morning.

I awoke optimistic and wondered if everything was actually brighter or if it was just my wishful thinking. The plane would be here this morning to take away my patient and all the pregnant women. Several more had been observed overnight for contractions, migraines, or other things. As much as I cared about them, I thought I wouldn't mind if I never saw their faces inside this hospital's walls for many months. Staff on the other floors were equally anxious to get their medical, surgical, or intensive care unit patients on a plane to bases in Texas and Florida.

I felt guilty for having some breakfast, when I knew the night nurse must be at her last, but oh well. Another day nurse and I decided to split the shift, so she headed down to the family's room while I went over to the unit where all the pregnant women and their families had spent the night. People were quiet, kids were eating breakfast, some people were still snoring.

I asked around about the status of the air evacuation and got a funny look. Someone explained that the first flight out would be taking all the tech school students. These are brand new kids to the Air Force, haven't even completed training for their first job. So they were to be sent somewhere to continue training.

"Alright, and then the patients, right?"

"Yeah, but don't expect it til about 5 this afternoon."

I trudged through the familiar darkness and a growing stench of murky, wet building and stale air to the family's room. Dim daylight made me a little happier, but tension rose in the room when I said the plane would be coming a little later. But neither parent asked questions and their resolve was strong enough to mimic patience. I gave them all the credit in the world. Big sister was asleep on a blanket on the floor. I think Dad had slept in the chair. Mom was concerned that an infant could actually be soaking her t-shirt with sweat, as was I. Everything was soaked from the heavy humidity and lack of ventilation in the whole building.

Currently Reading Marriage Made in Eden: A Pre-Modern Perspective for a Post-Christian World By Alice P. Mathews, M. Gay Hubbard see related