We have no answers to these unbearable algorithms in life

Originally published on KevinMD

Jim Morrison of the Doors once sang, “Petition the Lord with prayer … You cannot petition the Lord with prayer.”

But we did that. We petitioned.

On one side of the ICU, we had an 18-year-old girl, upper middle-class family, had everything. Beauty, brains, money, supportive parents, and she was off into this new bright world, choosing her college of choice. A simple surgery led to sepsis, severe sepsis that raged through her body.

Mom and dad at her side. Dad collapsing over her body, wishing for a miracle. We were all wishing for that miracle. Cheering on every better blood pressure and better temperature and better vent settings.

And then there was Sue. 21 years old, overdose, mom and dad deserted her, and she lead a life of despair, neglect and abuse. She could remember verbal and physical abuse as far back as 4 years old. She tried and she tried to climb that mountain of hope.

But it never came, and through defeat, she overdosed on her anti-depressant meds. She did a good job with her overdose. She was found down at her home, by a friend visiting her. 911 and CPR couldn’t bring her back. And with a slight faint pulse, she was intubated and placed in the ICU. Comatose, non-responsive.

We, the ICU nurses and MDs placed our “petition the Lord on Cee-Cee, the glamorous college student. Though we provided excellence in critical care to both young ladies. The bet was on.

And we lost. And with our loss, we knew we had to evaluate. Cee-Cee coded many times, until there was nothing left. Dad draped his body over his daughter, and sobbed and sobbed, and we all became defeated. We lost, we questioned, we had petitioned. And we lost.

Sue started to rouse. Started to give handgrips and grimace and squirm. ABGs improved significantly to where she was able to be extubated. There was no family member or friend to cheer her on. But after we, the nurses, realized that you can’t will one person to live and let the other person go, we rallied Sue on.

Sometimes, this job, this costume we wear, this stethoscope we wear, becomes unbearable. Tears of sadness for Cee-Cee, tears of unbelievable happiness for Sue. And Sue made it. Not only did she make it out alive, a year later, she sent us a postcard. She was standing on a mountaintop. Accomplished with inner peace. And she thanked us for believing in her.

Sue became a counselor, master’s degree, counseling people just like her. People who had met a dead-end in life. She wanted to share her life and give hope to others. And she did. Triumph.

Lesson learned: We can’t petition, we can’t bet. But we must be steadfast in what we do. And as the nuns once taught me in Catholic school as a little girl: “Thy will be done.”

We have no answers to these unbearable algorithms in life.

We have no answers.

She asked for comfort

Originally published on KevinMD

Mom. She was a feisty 100 percent Italian, straight from New Jersey. Her dad, straight from Italy, was a tailor and made the finest suits for New York and New Jersey businessmen. Mom learned this trade well. She could sew some of the most beautiful tailored suits for herself. She loved to cook and every night was a banquet, a feast which required up to 2 hours of clean-up time by us kids. The food was always delicious; the clean-up was always dreadful.

Mom loved the dinner parties she gave for Dad’s fellow businessmen from IBM. And she adored Jackie Kennedy. She wore her hair like her, dressed like her, as many women across the USA did in the 1960s.

Mom went back to school in her 50s and earned a bachelor degree in teaching. Soon to quit that job after her junior high school kids climbed out the windows when the end of the year dismissal bell rang.

Mom was pretty healthy, high blood pressure, high cholesterol, but always manageable. When she turned 60, she started to have rectal bleeding and abdominal pain. And her once “well nourished” body soon started to lose weight. After a visit and a colonoscopy from her physician, the biopsy showed cancerous colon cells. Soon after that, she was diagnosed with colon cancer.

A colectomy was performed. A segment of her colon was surgically removed. And the surgeon triumphantly announced, “we got all of the cancer.”

One year later, the abdominal pain returned. The liver was suspected. And with a CT scan, a large tumor in the liver was found. She went to a large hospital Institute. The best of the best. The experts. And the surgeon told her there was nothing they could do for her. The tumor was so large it was not operable. What about the “we got all of the cancer?”

Unpredictable, those cancer cells. No one ever really knows when they got it all. A sad truth. The surgeon said, “Get your house in order.”

My father and mother drove home in disbelief. Mom entered a support group therapy called the Can Care Cancer. Unfortunately, she was not alone. She saw small children, young mothers smiling and laughing and bald headed. Each day they had learned to come to grips with their destiny.

Mom did some rounds of chemotherapy but to no avail. The tumor just got bigger. And so after a week admitted to the hospital, she asked to go home. She wanted her bed at home. She made herself a DNR. She requested hospice, and she requested comfort care.

We got Mom home, and she would go into comas, and then wake up. She saw two angels standing behind my one sister. She’d wake up and look out her window and proclaimed, “oh those beautiful dogwood trees” and she’d slip back into a coma. We had to clean mom up; she was unaware of the need for a bathroom. The oncologist told us that if we fed her, we would feed the tumor. The tumor would get even larger and cause excruciating pain. So as a nurse, I understood “don’t feed the tumor.”

But as a daughter, it tore me apart. How hard it is to separate nurse role and daughter role. We three daughters would take turns taking care of mom, along with the assistance of hospice.

Mom woke up one more time and told us of the beautiful angels that were floating around her. I would have never imagined this passageway of death could be so beautiful. Her last words to us were of the angels she saw. And I was comforted by that. She let out a final breath as her arm dropped off the bed. Her once plump body, now very thin. And the wedding ring that she had worn for 43 years … fell off her finger and hit the hardwood floor.

The loudest sound I have ever heard. But I knew mom had landed. Landed into her hereafter.

Peacefully. In comfort. And pain free.