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[psalmpeople]

2023

As the year ends, and people wind down; I find myself sprinting. Breathless; I stop every now and then to catch my breath. The sun rises and the sun sets, and hurries back to where it rises. There is nothing new under the sun. Nauseated, I carry on. I am running on empty.

The sky pours. Sweather weather, they say. Families and friends gather. They are pensive, they ponder. How quickly the year has gone by. Some have loved, some have lost. Yet, most are contented. At least that's what social media portrays. What a year it's been. I am running on empty.

They say that the walls of hospitals have heard more prayers than the walls of churches. I think it may be true. I have been working everyday since late November. I am running on empty.

An elderly gentleman excitedly proclaimed that the first thing he was going to do once discharged was to see the Christmas lights. He has metastatic lung cancer. Could this be his last Christmas? Ever so often when I stop to catch my breath I start feeling. But I am running on empty.

[psalmpeople]

The rain hides your tears

the rain knows all my secrets

[psalmpeople]

17 Jun 2022

I See You

This has been such a difficult week. Remembering our mortality, remembering that our days are numbered. That the work we do now only serves to preserve and prolong lives. For only God truly saves.

I don't know which part of this week was particularly difficult. Maybe it was because I've been dreading it. My friends are on leave, I have two calls to do, and having my menses while having to be on call just compounds it. I was so tired. I think I still am. We've been running a Palliative ICU this week. The emotions have been too much for me. The grief, despair, and helplessness of the patient's family, I feel it too. I'm only human.

Medical futility.

We have hit a wall.

We recommend best supportive care.

I never had difficulties counselling families about extent of care. I still don't. But this week I really struggled with my emotions and it all peaked yesterday evening with a patient's wife.

He is on high inotropic support.

He is on the maximum ventilatory settings.

He is too unstable to start dialysis.

We recommend best supportive care.

This patient is a 70+ yo gentleman admitted the day before for respiratory failure. We did a scan and found that he has a huge clot in his lung, likely the cause of his shortness of breath and low oxygen level. I wasn't the primary Dr taking care of him, but I've heard they're a Christian family.

I've also heard the stories that his wife had told.

They don't have children, and lived and depended on each other.

They've never quarrelled in their years of marriage.

She wasn't a great cook but he never criticised her cooking and would always eat whatever she made.

They believed in God.

I was handed over that in the event he deteriorates overnight, he is for full active management. That mainly included performing CPR- mechanical compression of the heart should it stop, to try to restart it.

CPR is painful.

It can cause rib fractures.

He is on blood thinning medications.

That will cause a lot of bleeding.

These were things which crossed my mind as I thought about how I should speak to his wife.

We recommend best supportive care.

As his respiratory status worsened overnight, I was called mutliple times by the extremely worried nurse in charge.

Nurse: Dr can you come! His BP is very low! How?

Dr his ETCO2 very high!

Dr his SpO2 low! You want to call family to come down again?

Dr his wife very anxious by bedside, you want to talk to her? She's here already

When I spoke to her over the phone, my voice trembled. I don't know what got into me. I have discussed extent of care so often. It didn't feel right. I didn't feel right.

Me: Hi is this the wife of Mr T? I'm the night Dr taking care of your husband tonight. I'm sorry for calling you at this time, but it seems like he's not doing very well. His blood pressure is low, and his oxygen level is also not very good. That's a chance he might slip away. Are you near? Would you want to make your way down? I'm so sorry to have to call you to tell you this...

There was a moment of silence before she spoke. Her voice initially calm, but with a sense of urgency

"I'll come back."

At that moment, I felt the same despair and helplessness. How devastating it must be to have to hear that over the phone. To have to drop everything and rush back thinking this could be your last few moments with your favourite person you've shared countless memories with.

What if he goes when I'm not there? What if I'm not there during his last few moments? What happens then? And... What happens after?

These things crossed my mind.

She rushed back within 20 mins.

Me: Hi Mrs T, I'm so sorry. I'm so sorry to call you to come back again tonight.

Her: What happened? His blood pressure dropped more? It was ok this morning.. it was in the 90s this morning, how come now it is only 50s. What do we do?

Me: Mrs T, he is on medications to support his blood pressure already. It is quite high. But unfortunately his BP is not holding. It may continue to drop despite being on the medication. He looks like his sleeping because we have given him some sedation to keep him comfortable. But he can still hear you. Please, talk and pray with him. He can hear you.

Her: yes I prayed with him, I will do it again. A few years ago he was admitted, that time Drs said the chance of him surviving was 50-50. How come now like this. He is so sick now. Now his chance of survival...

Her voice trialled off.

Me: yes indeed, he is very sick. He's not doing very well Mrs T. I need to discuss this with you now. I know it's never a good time to bring it up..

Her: yes I know, I have decided already. I have decided that if it his time to go, the Lord will bring him home. If his heart stop I don't want CPR to be performed.

Me: ok no CPR if his heart stops. Mrs T, you may stay with him here. I'll let the nurses know. Please stay.

I didn't know how appropriate it was then, but I told her that the greatest comfort we can have is that we have eternal life. That our lives on earth are temporal and we will all return home to be with God. After saying that I rushed out, hid in a corner of the ICU and bawled my eyes out after I texted in the on call group "bed 7, DNR"

I didn't know why I reacted so strongly. But I was reminded that Jesus too felt sad when he saw the death of Lazarus, before he raised him after. I used to wonder why he wept, when he was going to raise him up shortly? Is this why we too, feel sad when fellow Christians die, even though we know with certainty that they have eternal life, and that we'll one day meet again?

I want to hold on to the confidence and certainty that we will all rise again. And not be sad for too long.

[psalmpeople]

Hahaha I cannot

#ilovememes

[x]

[psalmpeople]

Post 30 hours x 3 of work this week - how many masks can I put on a day to undo the sleep deprivation?

self-care bear 

[psalmpeople]

“Interestingly, God’s remedy for Elijah’s depression was not a refresher course in theology but food and sleep… Before God spoke to him at all, Elijah was fed twice and given a good chance to sleep. Only then, and very gently, did God confront him with his error. This is always God’s way. Having made us as human beings, He respects our humanness and treats us with integrity. That is, He treats us true to the truth of who we are. It is human beings and not God who have made spirituality impractical.”

— Os Guinness

[psalmpeople]

And all I remember is your back Walking towards the airport, leaving us all in your past I traveled fifteen hundred miles to see you I begged you to want me, but you didn’t want to But piece by piece, he collected me up Off the ground, where you abandoned things Piece by piece he filled the holes that you burned in me

[psalmpeople]

Like a wild flower; she spent her days, allowing herself to grow, not many knew of her struggle, but eventually all; knew of her light.

​Nikki Rowe (via quotemadness)

[psalmpeople]

4 Months

Gone in the blink of an eye. The best four months in the past four years.

The next four will be tough, but come what may, because the best is yet to be.

[psalmpeople]

The Grass Is Greener On The Other Side

Every turn I take, every trail I track

Every path I make, every road leads back

To the place I know where I cannot go

Where I long to be

See the line where the sky meets the sea? It calls me

And no one knows, how far it goes

If the wind in my sail on the sea stays behind me

One day I'll know

If I go there's just no telling how far I'll go

[psalmpeople]

Priorities

It's past 1 in the morning and I'm still awake. Trying to be sentimental reblogging lyrics of sappy love songs. LOL what a luxury such frivolity.

[psalmpeople]

We are such forgetful creatures it's sadistic

by patricia_tarczynski

[psalmpeople]

New Year No Clue

2018, finally.

[psalmpeople]

Cause darling without you

All the shine of a thousand spotlights

All the stars we steal from the nightsky

Will never be enough

Never be enough

Towers of gold are still too little

These hands could hold the world but it'll

Never be enough

[psalmpeople]

I Had This Dream, That in Another World, I Was Someone Else, Someone Not Me.

Part of my hospital chaplaincy duties is to write a reflection on how it’s going. Identities may be altered for privacy. All the writings are here.

—

The patient, Jerome, had a trapezoid-shaped hole in his head, and he told me it was from his son.

Jerome’s son had waited in his father’s home until he came back from work, and then he robbed him. Jerome fought back. In the struggle, his son had picked up one of those bright and shiny geode rocks the size of a torso, lifted it to the sky, and wham, in a sick, slicing arc, brought it down into his father’s head. The son was still at large. The father, after six months in physical therapy, still could not get the blood stain out of the carpet in his house. Jerome had lost his job at the oil rig; his wife had left him; his other son took two jobs to pay off the hospital bills, but one evening after dropping off his dad for PT, had been struck by a sixteen-wheeler and died on impact. 

“Chaplain, I had this dream,” Jerome said, scratching his old wound, “that in another world, I was someone else, I was someone better, that I have two sons who love me, my wife never left, I was still at the rig with the boys … I had a dream that I was someone not me. It was extraordinary. It was wo—”

He fell asleep, which he told me would happen. His brain needed to shut down when it overworked itself. A few seconds later, he woke up and apologized.

“I had this dream, chaplain. Do you ever dream that you are someone in another world, a different you?”

I visited another patient, Donnie, who weighed about 1400 pounds. His legs had been amputated and he was nearly blind. He had a neurological deficiency in which he couldn’t stop eating; he had become diabetic and was recovering from Takotsubo cardiomyopathy, or as it’s also known, broken heart syndrome.

“Chaplain, I just think,” he said, eating his third plate of pasta, “I was meant to do … something, anything. Anything. Not this. Everyone tells you that your life is meant to help people, but how the hell can I do that here? Look at me.”

In our chaplain training, we call this intrapsychic grief, the pain of losing what could’ve been and will never be. It is the loss of future, the theft of invested time. It’s not a tangible, physical loss, but an internal shipwreck, the imperceptible emotional shriek in our chest when the picture of life we had planned for so long simply dies.

Donnie, the blind, obese, bedridden man with no legs, ordered pizza for the whole floor. That was, he felt, the best he could do. I told him it was even better than that.

Another patient, Lorenzo, had been in a car accident a few days before, and he suffered anterograde amnesia. He was having trouble remembering the words he had just spoken. 

“Chap—you the chap, right?” He rocked back and forth in his bed, nearly clapping his hands in frustration. “My girlfriend is real worried about me, man, she real worried. I think I’ll be fine though, but my girlfriend, she real worried about me. I’m not worried, I think I’ll be fine, chap. You the chap, right?”

He repeated himself, perhaps, to find security in the canvas of his own assurances. His brain had resorted to a safe mode, to grip onto the word-balloons which were floating away, by constantly making new ones.

I was astounded and bewildered by how much a mass of gray pulp between our ears can determine the course of a life, and inside the soul-box of our neurology is the possibility of a hundred lifetimes, and I was angry that the tiniest neuron could so effectively demolish an entire world.

What separated me from someone else not me, except by the tiniest shred of a neuron, one misfired synapse, one slender thread of chance? 

Another patient, Tony, was telling me that he had gotten weaker and weaker in his legs until one day, on the way home, he had collapsed at the ATM and there were floating heads around him asking what was wrong, but they looked like demon faces, and he tried to kick them off but he couldn’t move anymore. Tony had some sort of encephalopathy that had caused brain lesions and he was seeing things that weren’t there.

“But you know, chap,” he said, breaking into tears, “I got this long-lost brother up in Boston, he’s my half-brother but he loves me like a full one, Mikey, this guy’s made of money and he offered me a room at his place, his house is on this fifty acre property, it’s a mansion. Can you believe it?”

I spoke with Tony’s sister, who told me that no such brother existed, and there was no room, no mansion, no fifty acres. It was a story that Tony had been telling himself for months now, when his legs began failing him. It’s all he wanted to talk about, this promised land. 

Oliver Sacks, in his book The Man Who Mistook His Wife for a Hat, writes about disturbed patients who “confabulate,” who spin tales all day long in a constant stream of chatter. They cannot help but conjure completely made-up yarns about meeting celebrities or devising inventions or discovering something remarkable, as if the widening chasms in their brain need a desperate momentum to thrive. Or, worse, such activity drowns out the long fall of personality into the abyss, into the unrecoverable ether. One story after another tumbles over the cliff; I may be the last one to hear them. 

It is my role to honor the burial of what can never be done. It is my role to remember what will never become. It’s not just my role; you and I need this more than we think. At every turn, every choice, we die a million deaths each day. How can we stand such a thing, except to tell those stories that never had a shot?

I had this dream … 

Suddenly, Jerome, the man with the trapezoid hole in his head, nodded off again, but his eyes fluttered, like someone was still home.

… that in another world …

He spoke, but a voice that sounded thicker, more weight, more verve. He sat up taller, his eyes closed but working. I took a small step back.

… I was someone else …

Jerome’s eyes quivered and he said, “I am the man from the other world.” He smiled, just for a second. “I am a hundred lifetimes, I am one of many. I am not who I could be.”

… someone not me.

“I am a life never had. I am the man in the dream. The dream wishes he could be the man in the other. We all wish to be awake in someone else. There is no perfect dre—”

And he woke up. Jerome blinked, saw me, and he apologized for sleeping again. I wasn’t sure if I should tell him about the other voice. 

He said to me, “Chaplain, thank you.” He held my hands, his eyes alive and fiery, wet and fierce. “Thank you for listening. I have to believe my son didn’t mean it. He did the best he could with who he was. I still love my son, in this world or the next.”

I left the room shaking. I questioned if I had really seen what I thought I saw. I repeated his words in my head, I replayed the eerie twitch of his eyes, the way his body slipped into another skin, another dimension.

I wondered if I had glimpsed, even for a second, a keyhole into other possibilities, like dipping a toe into the stream of the infinite, where a son did not ruin his father, where a man missed a car by inches, where a promised land of endless acres was waiting at the other end.

I thought about how we’re always dreaming of being someone else, and the others are dreaming of each other, wishing for a world they couldn’t have.

We survive the nightmare, I think, by dreaming. To dream is to cope. It is the brain’s essential defense against itself. We create new dreams all the time, a new canvas of assurances, to wake against the intolerable. It feels like a lie: but what is hope, really, except a story we tell ourselves in the dark to light the way? If it works, who is to say otherwise? The world continues to be cruel and unfair, but we do the best we can with who we are, to dream amidst the wreckage of what no longer is, to bend with the merciless wind. To even share pizza with the whole floor.

— J.S.

[psalmpeople]

😍

it’s Saturday morning so I drew the world’s worst pun

(source: http://instagram.com/nathanwpyle ) 

[psalmpeople]

Bottomless Pit

The more I learn, the less I know, the more afraid I am.