Standing in the ICU, anagram of incurable, and listening to Hoobastank (worst name since Rainbow Butt Monkeys) and “The Reason” coming from a little radio sitting at the head of the gondola (bed.) Yes, “The Reason” and listening to the staff listen to me recite the system-by-system, the (it-doesn’t-matter) lab results.He goes Mmph, hmmph, ummph,and I see that he has stopped listening to me, no one is listening to me, we are listening to “The Reason” and we are looking deeply into those closed eyes and we wonder: what is the reason for continuing?
And I like this song, hate the band name, and like the fact that the unconscious are serenaded, that they are called to from this shore as they float or sink way out there. They are on the adjustable gondola, and catheters drain their humours, and they are turned like rotisserie. But this man. He is glorified dead.
The chorus to the song: “And the reason is you.”
I think: me?
And the chorus nods.
The man is eighty. Pressors are doing futile pushups in his veins, and antibiotics are clearing the decks, and he could die a million ways in this place, the infection could get him, his heart could get him, his lungs could get him, his liver could get him. He is multiplicity: causes of death compete over his corpse, say me me and we say no no and we pump him, we massage him, we throw tow lines to his sinking gondola.
His fingers are blue; his lips are blue; and I am still reciting, I am running down the system-by-system, I move from one domino to the next, and I wonder: is it alright to sing the chorus to this dead man, the reason we are all here, mmph hmmph ummph, but like the causes of mortality which clamour and scramble, there are competing reasons in my mind: just what is the reason behind death, is there a logic to it? Why does a family want everything done when the best everything is nothing? What would this man want, if he could hear Hoobastank, if he could look deep into his closed eyes, if he could push the buttons on his gondola and after ordering a cigar, he might say: the reason is goodbye.
And we would wave happily, his radio would thrum, the cigar would be a good one and we would move onto the next patient, all the radios are tuned to the same station (otherwise the ICU din would be babble, gush, wheeze) and we would reckon the reason behind salvage as the attending would reason about the latest randomized craze.
But back to the reason: the man is dying, his one statement is I am dying, and we all wonder how to solve his riddle, how to fix him, when there is only when, his lips are when, his fingers are when, and I am almost done my recitation (die death dead dying death) when the staff looks at me and says, “What is the reason behind goal-directed therapy in sepsis?”
And I want to say mmph, I want to make the very sound the patient’s heart is making as it slugs out a lugubrious lub dub, I want to say, What is the reason behind the inevitable, but instead I answer in a systematic way and the attending looks back at the man, if this is a man, and says to the nurses Turn this knob, turn this dial, push this button and I write the orders down in the chart and the song is over, the reason is elusive, and the music calls out, Come here, come here, and I think for some reason about love and how that is the root reason, the song is all about love, and if this man could talk, if he could sit up with his cigar and treat us like his cronies, then he would talk about love.
But I was a crony. I sat and sycophanted at the knee of Dr. Mmph Hmmph. We were sitting in the QEII cafeteria and I had been pounded, it was a long night and a long morning and the patients were lining up to die on our glorious stage. We were waiting for the cafeteria to open, we could see the dietary staff brewing coffee behind the metal gate, and it was five minutes before they’d let us in. It was a tense time for me: how to pretend how this was the greatest specialty ever, how I wanted to grow up to be just like him someday, how I loved the system-by-system, indeed it was a kind of poetry, it was a summa of life (death) and method and in the bathroom as I took a shit I tried to mimic the mmphs and hmmphs of the good doctor. It was all seemliness: how to covey I was loving this, how I lapped it up. But I had a spiritual conversion: I had to know the reason why he did it.
It was a major mistake, to ask this. It meant that I didn’t know why, and asking questions like this meant I was making a judgement, and asking it had to be delicate. It couldn’t be too much of a question- that would give my attitude away. It had to be dreamy, I had to look into those dreary intubation eyes and whimsically ask a question, as if it were merely a rhetorical and, impossibly, hope for an answer.
But I had not had my coffee, I felt like I was dangled from the end of a pager, from the end of the PA system, switchboard had my number and they kept punching it, and if I didn’t ask him why he subjected himself (note: do not use the word subjected)to the torture of permanent and futile need.
I thought of a nifty way to ask the question. Ask him about pace, about how he sustains it with age- as if I were marvelling at his stamina. Perhaps that would get at the reason. Indirection.
But he mmphed his way through: something about loving his work, and his eyes were dispassionate as he said this, and that he got used to it. His reason seemed to be: adaptability. I had never seen him show an emotion, except when a line or tube didn’t go in, or a patient died before the absolute last moment, and then I saw anger, which was the frosting on fear. It was two minutes to coffee, and then I would have more stamina, but I realized that this next two minutes would be my best and only chance to find out the real reason. I could not give my contempt away.
Ask about how his family adapted to his absence? Nope.
Ask if the money was good? Possible, but crass and he’d just say yes. It just has to be.
Ask if there was any misgivings over prolongation, if he ever wished he could just decide if a person could die, unilaterally, damn the stupid family, instead of the callisthenics of life, if he wanted to kill the power in the entire unit at the end of one long mirthless session and let nature reassert its duty, if he thought all the money in the world couldn’t be a justification. If he wondered if the music he played for his patients was sincere, or if it was rounds music alone.
No, no, and no. Better to ask a question about a nuance of goal-directed therapy for sepsis, get him on his own system-by-system, get him rhyming but not reasoning, much safer territory, and the metal gate goes up and we are up, he is buying coffee for me (the least I could do) and we have no time to sit down, we must go back to the unit and massage time, we must do admissions without making an admission, I must watch and learn, I must realize that motivations are mysterious (I too wanted to make a difference, once, and I was merely marooned on the way) and there is always blessed work to take the thoughts away, there is music to aid the work, the chest compressions can be syncopated to the beat. With each chest compression, I say, under my breath: mmph.
***
It was evaluation time. The month was over, I had survived this, a place where alertness is under siege by death, where the machines contribute to an aria of din. The evaluation sheet had a number of checkboxes, a number of categories, ranging from excellent to unsatisfactory. I watched him as he mechanically checked all the boxes in the middle. He started by asking the classic question, “How do you think you did?” I wondered why all evaluators felt the need to ask this question. Was it to test if the subject was deluded? Was it to encourage the student to confess to their shortcomings, which would quickly be recorded on the chart? To be excellent was to be immune, to be as good and indifferent as mmph, it was to anticipate his needs, which here meant anticipating death. I always felt a little dead myself when someone died, a little like a failure. Perhaps this was what happened to him: there was so much death subtracted from him, there was only cool implacability, except when someone was dying wrong (the young, mainly) and something else was subtracted from him, something deeper, and it is too bad that he was also immune to irony.
I wondered if I should confess that I doubted whether there should even be an ICU. I had already realized that most people do not understand death, that they are not prepared for it, because if they were, they would not have wanted the cruel ICU rites performed on them. I wondered if the ICU should be decorated more as a mausoleum, if everyone should wear undertaker garb as unit uniform. But I wanted those middle boxes to stay in the middle, and it’s always the comments section that can get you.
I said the most neutral word I could think of: “Okay.”
He wrote the most neutral (and kind) words he could think of: “A hard worker.”
The evaluation was rushed, like all activities, here. These were the terms. A few more people had arrived to die, and he had to prepare them. The evaluation was less important than the real exposure: that I need to write down what I want when I die, which is mostly to be left alone. I wondered if I should write this at the bottom of my comments section. I thought it should be concise: “I never want to come back.”
But he asked me if there was anything I could suggest to improve the rotation, if there was anything which could be done to make the experience of the next student better. I fantasized: build the ICU on the top floor, make it accessible only through a series of trick closets, paint the walls, the floor, and the ceiling all black, have a secret handshake (the thumbs down), and provide a decoding manual for mmph hmmph. Encourage the student to look like you, to act like you: it’s more honest. Students should be vanity clones. Have a few VLTs to add happy sounds to the ambience. Install a big red button that when pressed, a disembodied voice says, mmph. Press it again and it says, hmmph.
But I am a sycophant, in the grand tradition of studentry, or merely a coward, and instead of suggesting a Hmmph-Mmph dictionary, I merely said: “No, everything was great, I really learned a lot, thanks for your time.”
We shook hands; the last time I did that, it was our first meeting, and I did not really know about death.
As I walked out of the hospital, the sun hit my ICU-habituated eyes and I had to cover them for half the walk to my South Street apartment, where my wife was accustomed to seeing me sleep, and where I resolved, immediately, to stay desperately awake, to be excellent.
***
Shane Neilson is a poet who published Exterminate My Heart with Frog Hollow Press in 2008. My Manic Statement is coming out with Biblioasis in 2009.