Saturday, January 30, 2010

When It Isn't A Stranger on the Table

This past week our case has been a 61 year old gentleman who presents to the A & E (Accident and Emergency here in Europe) with crushing chest pain. Naturally we've been working through the histology of heart muscle, the conduction system, the cardiac circulation. There have been graphs of enzyme releases and numbers relating to action potentials scribbled down. Pharmacology and receptors discussed ad nauseum.

I couldn't put my finger on it for a few days, but I felt out of touch with the lectures and the PBL discussions. Strange for me because the emergency nurse still living inside me loves cardiac presentations and interventions.

Then it dawned on me. My dad died of a massive heart attack. 

I know it is probably immediately obvious to most people why I was a little dissociated from the learning this week. But it truly was a surprise for me because we were examining this presentation at such a microscopic level that I truly didn't see the forest for the trees.

So to remind myself, and to all the academics out there that there is a human, a soul, a spirit that gives breath and life to the myocytes we spend so much time looking at slides of...I am reposting the story of my dad and his final heart attack. Because it is something we all need to remember, for every troponin level we're anxiously waiting for so we can turf the patient to CCU or home, there is a family that is also anxiously awaiting those results. 


When my dad laughed, it was a borderline giggle. As manly a giggle as you can imagine, but a giggle nonetheless. He really let loose though, usually turning his head to the side and scrunching up his shoulders while his whole body shook.

In a word, he was a 'character'. A prankster. Not mean or hurtful pranks, but anything he could get a good story from.

He would perform last-minute pranks, ones that involved no prep or props. Like sticking his big toe on the back of the scale when my mom was weighing herself, or telling the kindergarten kids that rode his bus that there were "two Friday's this week" so he'd be there in the morning to pick them up. My sisters current event for social studies class one day was that the "Pope had turned Protestant" thanks to my dad. He hid pork chops in the pockets of his friends coveralls on a Friday afternoon so that come Monday when they got back to work there'd have a nice surprise with their morning coffee.

When my uncle was particularly proud of his new television set my dad went out and bought a universal remote which he'd bring to their house and use to turn the volume up and down at infuriating intervals convincing my easily flustered uncle that he'd made a dud purchase.

One of his more elaborate stunts was when he surprised my mother on the 'throne' and snapped a picture of her, developed the photo and then cut it to fit in her wallet. I was at the supermarket with her the day she pulled her credit card out and with it came flying the photo of her on the toilet, landing right on the scan pad.

He loved it when I'd get engrossed in something scary on t.v. He'd sneak behind the couch and just as Hannibal Lecter was closing in he'd startle me with a "Haarr!" while I came a foot off the cushions, screaming and yelling "DAD!"

One Monday morning my dad's alarm clock went off for work and he didn't shut it off. His girlfriend thought it was odd because he was always up with the first crackles of the morning news. She turned over to ask him why he wasn't getting up and discovered that he was dead.

I was starting my first day of a community practicum in nursing school that day. I had been dreaming that I was at this odd wrecking yard which was more of a wrecking yard for people, not cars. There were these large looming pieces of ramshackle machinery and I was getting a tour. Just as the tour guide got to a group of Dachau-esque ovens and said "this is the crematorium" the phone rang, waking me up. I was shaking out the images from my disturbing dream but felt something else must be wrong because the phone never rang this early in the morning.

I picked it up to my mothers voice on the other end. She asked me if Benje was with me, I said yes. She said, "honey, your father died today, I'm coming to get you to take you to his place".

I don't remember many clear details from that day. But a few things are still with me. Sitting at my dad's kitchen table with my aunties and his girlfriend, my dog Cubby moping and whining around the house. A petite brunette who worked for victim services gave me some pamphlets and I remember thinking "what a shitty job you've got lady".

I had a professor in university who was a beautiful soul that had seen many tragedies in her time as an ER nurse in Toronto and Edmonton. On a shift when one of my fellow students saw her elderly patient die, Madeline sat us all down and told us how she helped families manage grief. Again and again she stressed that we ought to encourage families to make physical contact with the deceased, show them it is OK to touch their loved ones hand, or stroke their face. Her belief was it helped make the abstract concept of death more concrete. It gave tangible proof to push denial aside and let the beginnings of grieving grow.

The funeral home was at the end of a quiet street in the small town near his acreage. We were sitting in the funeral directors office discussing the upcoming autopsy and the cost and logistics of transporting a body back for viewing. I was tuning in and out. Wait, the medical examiners office? I had been to autopsies there. I hurried that thought out of my mind.

He informed me that I could save 600$ if they could have his ashes FedEx'ed to the church after the autopsy, rather than transporting the body. I howled with laughter, "Fed Ex!!??" I thought that was hilarious . Who knew you could have your ashes sent by priority courier? I was chuckling still when he answered me with a most stern, "yes". I glanced around the room and seeing that I was the only one who found this funny I stifled myself with a "hmfpf" and stared down at the balled up kleenex in my hand. When the funeral director finally asked me if I'd like to see my father I nodded and followed a few feet behind as he led me to the back of the room which served as a chapel.

I stood at the threshold. The length between me and the table which supported my fathers body seemed to stretch out to an impossible distance. The floor was gray linoleum and empty but for the body at the opposite end. To my left light streamed in through the dusty venetian blinds that were half open. On the right were brown padded chairs with metal legs stacked on top of one another.

The funeral director said he would step out to give me some privacy.

I just stood there staring straight ahead. I wasn't sure what to do. I wasn't sure if my legs could get me to the table. One side of my head was yelling "No! No! No! No!" and the other was hearing Madeline's voice telling us about encouraging families to have contact with the body. No way did I want some maladjusted grieving, stunted acceptance to befall me.

I edged forward and arrived at his side. His face was bluish gray. A small trickle of blood was dried in his ear. His mouth was hanging slack and he had enough stubble to warrant a shave. The white blanket was pulled up to his chin. It wasn't my father. The man who was my father had a mischievous twinkle, and was quick to laugh. This thing in front of me was an abandoned carcass. An evacuated shell. I saw that with his soul, his essence gone that he really had very little to do with his body. His skin and bones and eyes and mouth were just part of a complex interface required by his spirit to interact with the rest of us (who are also trapped by the same limiting coveralls). I knew that he had not come to an end  because having a heart stop beating could not cause such a dramatic metamorphosis to a vessel.

I thought for a moment that he was probably watching me, maybe circling above me somehow. I slowly reached my hand forward, intent on touching his shoulder. As I watched my hand get closer the moment of contact occurred. At that exact second a car horn blasted outside the windows. I jumped into the air and felt the rush of adrenaline hit my fingertips.

And with that I was laughing and waving my hand in the air.

"Hey Dad! Nice one. You got me!!"

So dad, if you're reading blogs out there in the ionosphere, this ones for you.


OMDG said...

Great, now you made me cry.

It's so easy when you're learning to be a doctor to become disconnected from what it's like to be a patient or a family member of someone who has died. You probably need to become somewhat disconnected in order to function properly, but I hope that as I go through this I'm able to remember at least a little.

Thanks for the story. I'm sorry you had to lose your father.

Nature Nerd said...

I love this story, especially the ending. It made me cry both times.

Albinoblackbear said...

I appreciate your comment. The funny thing is I wrote it in attempt to make people laugh but apparently the story has the opposite effect. I guess the two are close together and any emotional response is a good one in my books.

I agree you definitely do have to become disconnected to survive, but yeah a little reality check every now and again is a good thing I believe.

I know this week it was good for me to ponder some of the essential aspects that never really get taught in school--the fact that our 'another day's work' is someone else's life changing moment.

Albinoblackbear said...

NN--Awww...actually when I posted this I thought of you because I remembered that from a long time ago!

I am glad you love the story though, I do too.

Unknown said...

Interesting that both you and Dr. Charles wrote death-related posts today. Good stuff. Keep writing.

Best regards,

Albinoblackbear said...

Thank you William.

One of the catches of actually having people that read the blog is I feel compelled to keep writing.

Beach Bum said...

Some great and poignant writing! I hear you on the ambivalence toward certain material. I remember being completely unable to learn the material during a block on cancer, while I was waiting for some biopsy results. It's amazing how easily our minds will block out painful simuli.

Albinoblackbear said...

BB--Yes, it is the first time I've personally come across it and I wonder if it is a common theme with nursing/medicine/paramedic students.

Our brains do seem to be well wired for denial--oops I mean self preservation.