Wild Life

Background:

Twenty years ago, I was a volunteer for a wildlife rescue organization. We were a kind of half-way point between the public and federal wildlife rehabilitators, which meant that people were always bringing us injured wild animals (mostly birds, but other things too) in cardboard boxes. The woman I worked with was so tender-hearted that it fell to me to put down the birds who were clearly not going to survive. (I didn't like doing it, but I could do it so I did.) Some of the birds had been mangled in encounters with cats or dogs or cars, but many had been poisoned. You could always tell the poisoned ones because they would often be fallen over in the box, unable to keep their balance, and their wings would be twisted around them and their necks outstretched and contorted in strange ways. Their suffering was awful.

One day a Native American woman in her late 30s or early 40s walked in with a shoebox. I took one look in the box and knew that the bird inside had been poisoned. It was a pigeon. Pigeons are not federally protected wildlife--and besides that, most people don't like them, which is where the not uncommon idea of putting out poisoned food for them comes in--so we explained that we would take it from her, but that it had been poisoned (it and every other bird who ate the poisoned food) and was not going to survive. She asked what we would do with it and I said we would put it down. She said that in that case, she would take it home with her (which we allowed because it was not federally protected). She was not unpleasant or weird about it, which, in my exprerience, many people would have been, but I wondered about why she would want to take home this bird when it was so clearly suffering and was not likely to have a peaceful death.

That woman and that pigeon have been stuck in my head for twenty years. 

Foreground:

On Thursday, my patient was a scant handful of years younger than me, and four months ago, during a routine doctor's visit, they found cancer.  The chemo devastated her immune system, as it was meant to do, and then an infection set in. (Chemo can be a brutal kind of game, a poison meant to kill the cancer while gambling that you, also poisoned, will escape death, however narrowly. But it clearly doesn't always go that way.) Today she's comatose, hanging on until the family--husband, two young children--decide to let her go. They don't yet know that's what they're going to do, but that's what they're going to do.

She is full code, which means that when the end comes it will not be peaceful. The movies and television have allowed people think that CPR is just pushing on someone's chest and squeezing air into their lungs with a bag and mask, but that's just pretty pictures on screens.

We wore masks as we took care of her, to protect her from us. They can't find the source of the infection, so she's on a range of drugs to try to combat this mysterious enemy. A week ago, she was walking and talking and probably despairing about losing her hair, eyebrows, and eyelashes, and now she can't do any of that, and not just because of the sedation and the powerful pain medications that flow into her veins. She couldn't respond at all to any of us, but she was warm and solid, a dense living thing. The hearing is considered the sense that stays intact the longest, so we talked to her, letting her know who we were and what we were doing, letting her know that she was in the hospital and that she was safe.

Her husband put a photograph of her up in the room, a smiling, pleasant, handsome woman, and he only had to remind us once about the correct pronunciation of her unusual name. He is kept company by his sister and her sister. They all trade off so that she is never alone.

Her heart sounded strong and her lungs sounded clear to me. She was able to breathe for a time on her own with her sedation stopped and the ventilator turned off. Her family stood around her, encouraging her, but then she started to struggle, using her shoulders to try to pull more air into her lungs, so the respiratory therapist turned the ventilator back on and we turned her sedation and pain killers back on.

I helped take care of her for a scant handful of hours, but I came home feeling like someone had tried to pull me apart limb from limb. At home, I changed into my pajamas and I got into bed and I slept. And today I called in sick.

 Afterward:

"...life is like a gladiators’ arena for the soul and so we can feel strengthened by those who endure, and feel awe and pity for those who do not.” --Norman Mailer, The Naked and the Dead