Authors: Tilda Shalof
I look over my list. It covers most eventualities, but I am compelled to continue because according to the rules of my magical thinking, I must exhaust every possibility of disaster in order to avoid it.
This is a very progressive camp. It has a psychologist on staff by the name of Dr. John Fleming who gives sessions on stress management and relaxation techniques to anxious, over-scheduled campers and their equally stressed counsellors. He teaches them something called mindfulness meditation. After one week of sleepless nights, I cornered him after lunch today to ask for a private lesson. He agreed to meet with me at the picnic table under a big tree near the dining hall later this afternoon. Mindfulness? Sounds interesting, but can it help me in my situation? I am ready to hear what he has to say, but I’m a New Age skeptic.
The moment I sit down opposite John at the picnic table, I fall apart. Something about him makes me feel completely safe and I don’t hold back. Up until now, I haven’t cried, but in front of him, I allow myself to weep and wail and say all the dire, drastic things I’ve only been thinking and scribbling in my notebooks. He listens closely and intensely in a way I’ve never experienced. His listening is breaking me wide open.
He shows no reaction to what I’m saying. There’s no expression of concern or worry so I don’t have to protect or console him as I would a friend, yet he is not detached nor disinterested. Around my age, he’s also a parent of young children but doesn’t interject with his own feelings or identify in anyway with my problem. He doesn’t appear to be making a diagnosis, or judging me or drawing any conclusions. He offers no advice or suggestions. He sits implacably, radiating a benevolent kindness, an unwavering interest in my situation and respect for what I’m going through.
I finish crying and am ready to hear what he has to say.
“The basic principle of mindfulness is that rather than expend effort to fend off our pain, we simply stay aware of what we are feeling and thinking. Each time your mind goes to a fear, breathe and bring your attention to your breath.”
Is that it? Is this all you’ve got?
He goes on to explain that mindfulness keeps the heart soft and accepting. It is a way to focus the mind on the present so that you can be fully awake and aware to what is happening in this moment, now, without judgment. It cultivates a gentle friendliness to what is. It’s not a religion or a doctrine, but a practice of conscious breathing and meditation.
“Let’s begin,” he says. “Take off your sandals. Let your feet feel the ground.”
I do as he says and await further instructions.
“Don’t run from your feelings. Breathe into them. Feel whatever comes up, panic, fear, sadness, whatever. Sit and observe each thought as it comes and as it goes. See how you can survive each feeling and watch how it passes on its own.”
I try it for a few minutes but lose patience.
“Perhaps there’s a book you could recommend about meditation?”
One day I’ll meditate, I promise, but not now! I don’t have time for this
.
Note to self: Google mindfulness, meditation, serenity, etc.
We’re meeting again tomorrow. It’s a lot of work, this breathing.
It’s Day Two in Mindfulness lessons with John and I bring my lists to show him what we’re dealing with here, including last night’s entry:
John gives my notebook a glance and sets it aside on the picnic table, which makes me realize that the particulars of my situation are not what this exercise is about; it’s about fear itself. We return to the work of breathing. I take a desperate gulp of air like it’s my last.
“Let it out, too,” John reminds me. “With each feeling that arises, surrender to it. Identify each fear, then let it go. Meet it with compassion for yourself.”
My mind is full of scary thoughts. “Bad stuff keeps coming up.”
“Escort each unwelcome guest to the door. Note the thought and the feelings it creates, then let them go.”
I sit with that for a minute or two. My eyes pop open. “Just to recap, what’s the
purpose
of all of this?”
“To bring us back to the present, to an awareness of this moment, which is all we have.”
I look up at the sunlight shining down through the trees making them so bright and green. The blue lake peeks through the leafy branches, sparkling in the breeze. I understand that what I’m looking at is beautiful, but I can’t connect with it – I barely see it. It’s as if I’m not even here. I’m already on the operating table, the surgeon’s scalpel poised above my chest, about to cut into me.
“Should I keep my eyes open? Closed? Assume the lotus position?”
“It doesn’t matter. Just sit and be aware of what is right here now.”
“Hey, John. I’m sorry. I can’t do this. I don’t want to waste any more of your time. Meditation is not for me.”
“Just breathe,” he encourages me, “in and out.”
I can’t still my chattering mind. I strain to hear him over the static in my head.
“What are you feeling?”
“Terrified!”
“Pay attention to how your thoughts create your feelings.”
I close my eyes. “Am I meditating yet?” I ask after a few more minutes.
“We’re not there yet. It may take a lifetime to master.”
Who has time for this?
I open my eyes. “This isn’t working.” He doesn’t get it. He’s not the one who has to go under the knife, have his chest cracked open, his heart stopped. I look at his kind face, his fit, athletic body. Every morning, he goes for a ride in the countryside on his mountain bike. What does he know about physical limitations? I shake my head. “I have to get back to work. Keeping busy is the only thing that helps me.”
The next morning I am practising my own brand of meditation as I treat the kids’ various ailments. I put a bandage on a kid’s arm and breathe in deeply. I give an antihistamine for a case of hives. A wave of panic washes over me and I wait and watch it subside. The kids push to the front of the line, each wanting to be seen first. I treat them and momentarily they’re satisfied. But there is one child whose need is endless.
“I have a question,” Kevin starts up again. I try to ignore him.
“Can I try your stethoscope?” he asks.
“No,” I snap at him, all serenity vanished.
“Why do the pills come in different colours? What do they taste like? Are there flavours? What’s the strongest one?”
“In the wrong dose, they all can kill you.” I shoot him a menacing glare.
Scram, kid
.
“I have a question.”
“Just one?”
“Yes.”
“What is it?”
“Can I ask you privately?”
“Of course.”
“Do I have to make an appointment?”
“No. How about right now?”
I have a question, too. Does this kid do anything but ask questions?
We go outside and sit on the grass and I wait for the question.
“I don’t know what’s wrong with me, but I’m not having a good time at camp. What can I do to help myself feel better?”
I look at him, his freckled face focused on mine. This is a good question! Now we’re getting somewhere! We talk for an hour and plan strategies. He will focus more on the activities he enjoys, cross off days on the calendar, and come for daily talks with me. I will arrange with his counsellor for him to have downtime, some quiet and privacy that there is so little of at camp. My advice is practical, but maybe John’s approach could also help him to feel better. I will arrange for them to meet tomorrow. Kevin returns to his cabin in better spirits, as I do to mine.
My stint at camp is finished. My kids are staying for another week and a half, but it’s time for me to go home and face the music –
Open-Heart Surgery: The Musical
.
Alice and I go to our cars and she asks as she always does at the end of our time at camp, just as we are saying goodbye, “Will you come back next year?”
“Yeah, if I’m still alive.”
She laughs, assuming it’s a joke. She doesn’t for a minute think I’m going to die. Probably not, but there are many other possibilities.
“You’re strong. You’ll make it,” Alice says, echoing Mary.
“We’ll see about that.” I hug her and try to commit her embrace to memory.
A few days after I’m home from camp, I go to the hospital to visit Steven. Outside his door stands Albie, his elderly father, who looks like he should be the patient. Stooped over and breathing heavily with chronic lung disease, he’s had congestive heart failure, diabetes, and lots of aches and pains for years yet keeps on keeping on. “They’re going to have to shoot me,” he always says.
He brightens when he sees me. “Pssst …” he says, waving me over. “Here’s a hot tip. D’you wanna sell more books? Put in a centrefold. I’ll even pose for it. How ’bout it?”
I’m so familiar with this old-man Jewish humour that it doesn’t bother me, even at a time like this. It comes from a long cultural tradition of laughing through the pain.
“How’re you doing, Albie?”
“Steven is sick, but he’ll be just fine, don’t you worry. As for me, I’ve never felt better! I have a bowel movement every morning at 7:00. Problem is, I wake up at 7:30.”
I can’t help but laugh, but then remember something. “You had a bypass, didn’t you, Albie? When was that?”
“Take a guess.”
“2000?”
“Close. 1986. Quadruple. Yup, I’m a charter member of the Zipper Club.” He lifts up his shirt to show me the long scar on his chest.
“What was it like?”
“A piece of cake! A walk in the park! My problem is I’m having too much sex.”
“Shhh …!” Carol, Albie’s wife, admonishes him.
Albie may be in high spirits, but Vanessa knows the score and she’s worried. “Steven looks terrible,” she says. “Please go in there and tell me what’s happening.”
As soon as I go in I understand. What’s happening is that Steven is crashing. His systolic blood pressure is hovering in the seventies, with his mean arterial pressure in the fifties. (In the
ICU
, we usually aim for at least a
MAP
of sixty millimetres of mercury (mmHg), the absolute minimum necessary to provide blood flow to the coronary arteries, brain, and kidneys.) Steven is gasping, hungry for air. Even worse is that his heart has slowed down to around fifty-five beats per minute. A healthy heart responds to stress by speeding up to maintain cardiac output. The nurses sit, chatting. When they get up and move, their feet are in cement. This man has a very poor prognosis, but at this point he is a
full code
.
“Hey, listen up!” I clap my hands to get their attention. “This man is in trouble. He needs central
IV
access, an arterial line, fluids, intubation!”
“Are you family?” one nurse asks.
“Yes,” I say, after a nod from Vanessa. “This is an impending arrest,” I say, stating the obvious. From the nurses, there’s no response. Why aren’t they doing anything? “Where’s the doctor?” I ask.
“I have no idea.” Steven’s nurse bends down to empty the urine bag for 1600 hours and dutifully charts the two drops she manages to squeeze out of the urometer.
Steven’s kidneys are shutting down, but even more pressing is that his oxygen saturation has plummeted to 74 per cent. “Turn up his oxygen!”
The nurse says she doesn’t know how and even if she did, they aren’t allowed to adjust oxygen flow. Steven’s blood pressure is
dropping farther. He needs fluids and probably an inotrope to constrict his vessels and boost his pressure. I don’t trust the blood pressure reading on the cardiac monitor because the wave form is dampened, so I go over to take his blood pressure myself the old-fashioned way, with a cuff and stethoscope that’s hanging on the
IV
pole. It’s barely detectable. But the systolic is around sixty, lower than what it shows on the monitor screen.
Steven’s heart is dying before our very eyes
.
His nurse sits at a desk, busy with her charting, probably writing something like,
Difficult visitor. Will call Security to remove visitor if disruptive behaviour continues
. The other nurse pretends to be very busy, tucking the covers around an elderly patient, settling him in for a nap. How to wake them up, galvanize them into action? I don’t care if I’m out of line. People die because of this kind of indifference, this antiquated view some nurses have of themselves that they are helpless or powerless.
But I rein myself in and soften my tone to be more diplomatic.
“You might want to call the doctor,” I say gently.
“He’s busy,” the nurse answers.
“Tell him the patient is crashing. He’s about to arrest.”
She glares at me. From across the room, the other nurse stares at me. Their expressions seem to say,
We’re just nurses. There’s nothing we can do. What if the doctor gets angry at us?
They’ve given up. If I wasn’t so caught up in the situation and my feelings for Steven, I could actually muster some sympathy for them. I was a nurse like this, once. I remember feeling so constrained and afraid. I know the frustration of seeing problems but not having the means to fix them.