Incensed

The family arrived after the 10am appointment time. We gathered in a windowless room where I and the doctors stood as our patient's wife, son, daughters and son-in-law sat before us. I took the lead "...Your husband remains very sick on the ventilator with no sign of meaningful recovery. As you all know you presented an affidavit that tells us that your husband and father would never want to spend his last days on a ventilator. The affidavit has now been approved as clear and convincing evidence by our legal department and this means that we can fulfill his wishes as transmitted by you -his loving family- and remove him from the ventilator". The family had some questions; "He looks better today than yesterday, does this mean anything?" A good question. We had noticed that the edema had subsided and his oxygen requirement although high at 50%, was the best in weeks. This seems to happen a lot. A profound decision is made and a patient suddenly starts looking a little better. I cannot say it does not perplex me and make me question the process. There is nothing certain in life or death.
The medical team is confident that the changes are unimportant in the bigger picture of this patient's multiple morbidities and we say so, but we all 'caught ourselves' momentarily inside, I know.
"That's it we have no more questions".
I go to the room, the morphine is running lightly and smoothly, the patient is unconscious but moves and can cough. I move the bed to sit up my patient to a comfortable position. I prepare the non-rebreather mask, remove the ties that hold the breathing tube in place. There is no room for the whole family between myself the ventilator and the IV poles. There's a lot of straining and reaching. I deflate the cuff on the ET tube and quickly hit the mute button on the ventilator. I pull the ET tube out and cover it with a cool blue chuck.
Mr. Saieed breathes without any distress. I change the alarms on the bedside monitor, it will only alarm if the heart rate goes below 25, and the other parameters I disable. I suction the patient's mouth and wipe his lips.
I tell the family "He has his wish, talk to him, be with him. I will be here for you throughout the day."
A couple of hours later I get a call- I was already on my way. One get's a sixth sensual feeling for these things. I arrive, the patient's vital signs have ceased; the numbers returning to zero. The family is distraught. They are talking to him. They are loudly saying his name touching him seeking a response. "Pa? Pa?"
This too is something I have observed. A medical team can never anticipate the crashing orchestra of emotions and memories that accompanies the death of a unique loved one. The finality -although perhaps often clear to us- is rarely completely accepted by the family.
His wife runs to me and holds me crying, she puts her head on my shoulder, I hold her tight. Those cultural competencies and societal mores I read about fall back onto the pages of my old textbooks. The eyes of his daughters are intense clear greens filled with tears and unanswerable questions. They appear lost.
The family members cry and talk to him. His wife ungrips me and tells me "He never said a bad word to me in his life, never, he was a good husband."
I stay with the family briefly, but my work is mostly done now, I quietly continue to be -most importantly- a witness.
I exit the room, the curtains are partly drawn. Suddenly I am surprised as a huge cloud of smoke suddenly shoots out from behind the curtain with the intense pungent smell of incense. In a hospital unit like this, lighting anything is strictly forbidden. I know this. I am torn by the impropriety of the action. I stop to think momentarily. Then I smile and walk away.

The Same Cloth

For World Malaria Day 2008

The same cloth

The same piece of cloth
They carried you on as they rushed your body in
Thick saliva rolling from your open mouth
Eyes disengaged.

The same green cloth that held you tight from birth
To your mother’s back
How deftly she wrapped you in and up and laughed
Coming from the market.

Now she stands stripped of fabric and form
Watching over your tiny body
Which lies aligned and straight
As never before in life.

Eyes half open
Looking out beyond the sky
Your velvet skin immobile
Weeping on patterned cloth.

Gently your father rewraps you in it
As travelers always do
Like a parcel of food
Prepared for a long journey.

And held out like an offering
You are quietly borne away
In that same cloth-covered bundle
See how all the edges are frayed!

Burundi Lives!

WHAT DO I KNOW ABOUT DEATH AND HOW SACRED IS LIFE, REALLY?

I FOUND THIS IN MY DIARY FROM BURUNDI September 2005. I'M WRITING IT HERE AS I WROTE IT THEN.

How sacred is life, really? Oh how we talk and point the finger at the relative by the grave who shows no emotion. The daughter who does not cry, the wife who sheds no tear. Immediately suspect of something- cheating, lying or living a lie. All the lies lying in the mind of the observer, hmmm. Anyway the tears are never really for the dead only for and from the living - sadness yes, but a life well-lived should bring as many smiles as tears.
So what do I know about death? I lived through the fear of AIDS of dying myself and lived to see my young friends die and I continued to grow older than they ever did. I caught up and overtook their ages frozen(so wrong!) where they fell. And all of us so young then to have to die and see them die...
And so I became a nurse and soon find myself among the dying and see my first real live corpse, a chinese lady as I remember. Nothing there! And nothing so 'sacred' I could see. That was interesting seeing just a shell.
Growing as a nurse opening to meet the grief that comes at unplanned endings. The almost sinful joy I found at meeting loved ones at the edge and learning as I tried clumsily to comfort. Every death a lesson surrounded by waves of grief radiating out. Lifting me often. Tides of life.
September 11th my eyes looked into those of a young woman burned in an instant of terror in terror. Less than a week later I drag her mother screaming with grief and disbelief to the emergency room as her daughter died. What did I know?
And years later here, now- I watch as beautiful pale black children sink and die from malaria too late to treat or save, eyes focussed elsewhere. The breathing stops when all other systems are exhausted.
And the African mothers and fathers what do they know about death?
" Oh they're used to it", "it doesn't affect them like it does us", "they have more children anyway". Really. If I only knew what they know about death.
What do I know?

N'djamena -built on sand

Goz Beida - flat surrounded by hills