december pages

dear muffin,

hi. remember me?

I feel like a wombat that just crawled out of its cave after a long hibernation, blinking in the crystalline sun & suddenly remembering what wind tastes like. [whether or not wombats actually hibernate is entirely irrelevant.]

the fact of the matter is, nursing school is over. the chapter is closed, every word read. I am now one of those post-grad creatures wandering between the world of textbooks and an ever-growing pile of job applications. I said goodbye to Harper for the last time today & felt just a bit sad. a chapter of my life was lived in those hallways, and I'm always sad when a page turns. no going back.

mostly, though, I miss the ER. I miss Doug & Kate & Chris & Diego & Rachel & Justyna & Kurt & Lori & Ryan & Amber & Dr. Sevier & Adam & the other Adam. I miss the jokes and teasing. I miss the crazy patients, nice patients, frightened patients, grumpy patients. I miss the warm rush of satisfaction when an IV slides into place. I miss feeling like a grown up as we all hang out in the break room, eating our lunches and talking. I’ve grown over the past 8 weeks, and I know I’ll remember these days as some of the best in my life.

* * * *

the ambulance theme song catches my attention from across the nurse’s station. I close my charting and jog over just as Kate, my preceptor, picks up the receiver. “This is Northwest Base, go ahead.”

“Northwest, this is Palatine 25. how do you copy?”

“loud and clear, Palatine. go ahead.”

“alright, we have a 73-year-old man found non-responsive at home after a suspected heart attack. he was PEA on the monitor when we got to him, but since then we’ve been able to feel a carotid a few times. pulse is gone now. we started compressions, put in a King airway, & got a line in him. bringing him in now, ETA 6 minutes…”

someone scrambles to call a Cardiac Alert for room Bravo-2. we pour into the room with a crash cart, clearing the floor, piling equipment and priming bags of fluid. we are ready when the paramedics burst in with the wheeled stretcher, delivering chest compressions as they approach.

a paramedic gives report amidst the flurried activity. “we’ve given him 5 doses of epinephrine but haven’t gotten a pulse back. he’s gone into v-fib a few times, but mostly he’s flat-lining.”

I catch sight of a tech about to draw blood; in a burst of courage I flag him down.

“hey, I’ll start an IV and get blood from that instead.” he nods and pushes the tubes and tourniquet in my direction. I jump in without thinking twice.

the patient’s arm feels like cold wax beneath my fingers; dead weight. there is no twitch when I slide the needle into his vein, no exclamation of pain. his arm jerks rhythmically as someone delivers chest compressions. I calm my breathing and search for the blood flash. bang; got it. the IV is in. I hang a bag of fluid wide open and step back.

“I need a med nurse!” someone calls. I don’t even hesitate.

“got it! what do you want?”

the doctor considers. “epi. let’s try it again.”

I have never set up an epinephrine cartridge before. once, after a simulation, my instructor passed a cartridge around and explained how it works. “you pull off the yellow tab, twist the two parts together, and you’re set.” now, staring at the pieces as I dump them out of the box, it seems more complicated. I jam the cartridge into the injector and double-check with the tech.

“did I do that right?”

he nods. “you’re good to go.”

“Kate!” I call as I scrub an IV port. “first dose of epi is going in... now.” she nods and records the time.

thump, thump, thump. the room is still except for the tech delivering chest compressions. it feels like we’re holding our breath as we wait for the epi to take effect.

flat line.

10 minutes of compressions and 2 doses of epi later, the doctor uses an ultrasound to check for heart activity.

“I got nothing. anyone object if I declare it?”

no one speaks. we know there’s nothing else to be done; 7 doses of epi would jump-start a stone.

“alright,” says the doctor. “I’m calling it at 4:33. you can stop compressions.” the tech steps down from his stool and drags a shaking arm across his forehead. compressions are a workout by anyone’s standard.

“I’ll send the family to the viewing room. go ahead and get the body ready.”

suddenly, the room is quiet. it’s just me, Kate, and a tech. Kate is filling out her time-keeping page, so I turn towards the bed.

the white body lies bare, glaringly pale in the fluorescent light. his chest is extended as though with a deep breath; the ventilator left air in his lungs. I stare for a moment, half-expecting an exhale to relieve the tension. but he lies rigid.

“hey, would you mind…?” the tech points towards the man’s eyes, and I realize I’m the only person still wearing gloves. I step over and gently press the man’s eyes closed, but not before I see the vast emptiness staring up at the ceiling.

“the family is here; I’ll take him over,” announces someone in the doorway. with that, we are alone in the room, left to clean up papers, plastic packaging, and EKG stickers off the floor. to prepare the room for the next patient.

life is a thread. this christmas, look around you at the people you hold dearest. notice each one. because pages turn, & you will never return to this one.

I hope today’s page was beautiful for you. tomorrow, we will share a page. & I am thankful for that.

love always,

rory

the moving days

dear muffin,


today saw the start of real packing. school room = bomb scene. we went through all our books & sorted them into keep, throw away, give away, & sell piles. emphasis on piles. everywhere. 

also got to thumb through some old notebooks, which was simultaneously horrifying & hilarious. really, I don't think any kid went through so many handwriting transformations as this one. there were some sketchbooks, too, & "Queen Kristen and princessess" was a repeated theme. not sure whether the "princessess" were supposed to be Queen Kristen's daughters, friends, slaves, or papparazzi... but they were all at least two heads shorter than the Queen herself. humility at its best.

it's strange going through old schoolbooks. it throws me right back into that chair, pencil in hand, with the schoolroom lights burning on my neck while I scribble my way through workbooks. doesn't seem like that long ago, but so much has changed. & it's changing again.

it's not that I dislike the new place. but it's just that: new. at least, as new as a 40-year-old house can be. the stairs creak unfamiliarly, like they do at a new family's home when we go for dinner and ask polite questions in an effort to get to know each other. who are you? what is your story? where did you grow up?

I grew up on 731 New Mexico Court, in the house that used to be orange. the house with the pine tree out front that hosted mourning doves every spring until we cut the tree down. somewhere in the front yard is buried a pile of my eight-year-old treasures: pretty pieces of broken glass & small toys sacrificed for a pirate's cause. in the back yard was buried a time capsule that my brother & I opened only two days later, after a summer rainstorm washed away its cover.

I've lived here since I was 5 years old, and anything prior is a mere scrap of memory, a snapshot image of a yard filled with sun or a porch looking out onto a street I can't quite picture.

this town is my town.

***

leather burns against my skin as I slide into the back seat of the car. my brother buckles, revs the engine, & turns the radio up to blasting. country station. I know the lyrics by heart. my seatbelt clicks into place, the windows roll down, & we back over the curb at the end of our driveway. Mr. Thomas waves before disappearing into his garage next door. my brother turns the car 360 & punches the gas.

sun in my eyes, wind in my hand as I trace waves out my window. the town slips between my fingers; I see my siblings laughing in the front seat, noiseless as the whole car throbs with bass from the radio. I can feel the song pulse through my ribcage. my sister's cheeks are pulled tight with laughter & judging by my brother's facial expression, he's singing falsetto right along with Taylor Swift.

scenes flick by my window. the Chinese lady walks her little black dog. the older gentleman sits in his lawn chair, watches traffic. the marquee displays time & temperature. my brother instinctively squeezes the brakes as we pass the police station, then picks up speed once clear of dutiful enforcement radars.

this town is my town.

sometimes I feel as if we owned it, my siblings & I; as we walk through the parking lot & up to the sliding doors of Food4Less, I momentarily have the irrational feeling that we could take on the world. the cashier recognizes us with a laugh; since we can be found roaming the aisles at least three times per week, a few employees have begun to remember us. she asks us how we're doing, & we ask her how the cancer treatment is going.

we're back in the car, headed home with groceries in hand. my brother suddenly turns down the radio and says quietly, "you know, it's strange. this move is going to be the end of an era. 'the Elk Grove house,' we'll call it. 'remember when we lived in the Elk Grove house?'" for a moment we stare out the windows, seeing nothing. then the radio climbs back to a normal volume, and we drive home in silence. I know the song, but don't feel like singing anymore.

the Elk Grove house. remember when...?

***

change. it takes hold of the rug beneath our feet & jerks it sharply. it puts normal in a blender, turns it up on high, & hands us a fresh plate of the unfamiliar. someday this change will be the new normal, & I will know those creaking stairs in Woodstock as well as I once knew the ones in "the Elk Grove house." someone else will move into the house on the cul-de-sac, and they will begin the task of memorizing the pattern of air-conditioning cycles. they will soon learn that if you step on the right side of the 1st, 3rd, and 5th basement stairs, no creak will give away your midnight presence after a sibling movie night.

right now I see four blank walls & an empty floor, windows overlooking a foreign yard full of foreign Woodstock... but someday I will look & see my bedroom. I will glance over my shoulder & revisit the days leading up to the moment: the boxes, the cleaning, the packing. each memory will follow on the heels of another, forming an unbroken line between then & now.

I'm going to miss all this. I'm going to miss it like crazy. I'll miss the Food4Less, the goofy green-and-orange clock tower my town built to copy Schaumburg's, the way a police car always lurks behind the school on Biesterfield road. I'll miss being able to run over to starbucks with you at a moment's notice.

but that's not really it. it's not the town; it's these times I'm going to miss. because I know that life is changing fast, that it has been for a while now. "the Elk Grove house" will forever be home to some of my favorite memories.

tonight I sat on our green basement couch, savoring the familiar touch of knobbly fabric, and considered some of the changes in my life up to this point. I remember hating the idea of visiting a new church; then the pain of being torn away once we'd become attached to it. I remember the uncertainty of starting our own little church; now I wouldn't trade it. I'm old enough to understand that God works things out for the best, & young enough to kick and scream anyway.

promise me you'll come fill up the new house with new memories? it's a blank slate, ready to be scribbled on. with some good friends to help, it shouldn't take long to transform the newly-painted walls. I claim the yellow crayon.

we can open the new chapter together.

always,

rory

life is beautiful

dear muffin,

she was nervous. I couldn't blame her.

terse replies were all I could draw out as I finished my work; her face was taut, expressionless.

it's doubtful that anyone in the history of the scalpel has not been nervous in those moments of waiting. moments before the wheels begin to clatter along tile floor, rolling past sterile operating rooms. after all, the idea of having one's insides opened to the world has never been a pleasant one. 

"okay then! I think we're ready." the nurse deposited an armful of IV bags & tubing into my waiting hands. "make sure you keep that piggyback higher than the primary fluid," she said in my direction. 

we helped the woman onto her feet, allowing her to smooth back disheveled blonde hair, & began the procession. the nurse led the way with routine briskness, followed by the patient herself. I took up the rear, holding the IV bags at shoulder height & keeping the train of tubing off the floor. 

her surgery was scheduled for 0800 hours, which meant it was already 30 minutes behind schedule. but no matter. the mass of foreign tissue growing below her diaphragm would be removed, the incision sutured, & before she knew it the whole ordeal would be over. still, no reassurance can shorten the moments before the plunge.

inside the operating room, every surface glinted in sterile perfection. scalpels arrayed with mathematical precision, gauze neatly stacked, suction equipment hooked up & tested. sterile blue drapes were spread over the table, ready to receive the patient.

"and, the surgeons are here." announced the circulating nurse. "Michelle, you want to get them ready?" the scrub nurse nodded & began unfolding blue plastic gowns as the surgeons poured into the room, followed by the woman's husband-- who looked ready to faint. while they scrubbed in, the anesthesiologist struck up small talk with the patient.

"so. how're you feeling?" he asked after a moment. the woman laughed shakily.

"you know that part on a roller coaster, when you're going up & all you can hear is 'click...click...click...?' that's what this part feels like." 

"alright!" announced the head surgeon. "we're a go." the light glanced off the first scalpel as it went in. 

blood. blood trickling down a swollen abdomen. the smell of burnt flesh as cautery hits blood vessel. the surgeons opened the skin with a smooth cut & then burned back the yellow fat beneath. I moved to get a better view.

there; I could see it. a mass rose into sight as the abdominal muscles separated. it was smooth, taupe-colored, with a complex pattern of blood vessels visible beneath the surface. it was larger than I had imagined. the surgeon made one final slice, reached in deep, & pulled. as he lifted, the foreign body came free in his hands.

he held up 8 pounds, 3 ounces of tissue. & as he moved it towards the light, it kicked him.

the room launched into motion. nurses closed in, transferring the now-wriggling mass to a table. the table disappeared from view as blue scrubs bent over to perform a well-practiced dance.

"heart rate 150."

"BP 67 over 35."

"O2 sats?"

"68."

"looks good!" announced the pediatrician, laying aside his stethoscope. a nurse gathered up the bundle & brought it over to the woman & her husband, who was furiously rubbing away tears of joy.

"Here you go," said the nurse with a smile. "Congratulations; she's beautiful."

-rory