By A Canticle for Lazarus
05, 2016 "Information
Canticle for Lazarus"
underwent a relatively minor – but surprisingly
painful – outpatient surgical procedure. I spent
the next two days crashed out at my parents house in
a haze of Percocet, Zofran, and Ibuprofen. On day
three I stopped the narcotics, preparing myself to
return to work.
pain didn’t stop.
I spent day
three on the couch, certain that once I got past
72-hours post-op, the swelling would subside and the
pain would cease.
pain didn’t stop.
and five were a complete loss. The incision site,
near the base of my tailbone, ached with any
movement; I missed two days of work because I
couldn’t walk without feeling as though someone was
stabbing my spine. I couldn’t sit upright in a
chair without a wave of pain crashing over me with
such strength that it made me nauseous.
So I spent
those days crashed out on my own couch, still
unwilling to take narcotics, curled up with Aleve
and a heating pad, guilt-ridden about missing work
and generally feeling sorry for myself.
morning of day six, I called the doctor’s office,
and spoke to the nurse.
it would be almost completely better after day 5
post-op,” I said, worried. “And it is better,
but it’s still really painful.” I had it firmly
implanted in my brain that my recovery would only
take five days. I have no idea where this number
came from, but I clung to it desperately, a
life-preserver of hope in a sea of discomfort.
she said, startled. “No, I think you’ve got another
week or so left to go. Most patients with surgery
at that site say it takes about two weeks before
they’re feeling better.”
I spent day
six profoundly depressed.
off my phone; I ignored my overflowing inbox. I
missed a lunch with some co-workers, too depressed
to get out of bed and into the shower. I watched
seven hours of television on YouTube, all shows
about trauma care and the ER: “An Hour To Save Your
Life,” “Baghdad ER,” “Real ER 911: The Bronx.”
I took one more Aleve, wrapped myself up in a
blanket, and fell asleep.
~ ~ ~
I woke up
at 10pm, a normal time for me, as a night-shifter,
to wake up when I “sleep in.” I sat up at the edge
of the bed, and it hurt.
was still there, and now I was angry. I was tired
of being in pain. I was tired of missing work,
missing the outside world, missing sessions at the
gym, missing hikes in the mountains.
I was angry
at myself for undergoing an elective procedure for
something that had just been annoying, and was now
acutely painful. I was angry at myself for not
planning this better; I was irrationally angry at my
surgeon for not telling me that I should schedule a
solid two weeks off from work. In retrospect I
realize she probably did tell me this, and
I hadn’t listened.
I was angry
that the pain was interfering with the life that I’d
built up around me, a life that I loved living.
As soon as
the thought formed itself wholly in my brain, I
froze in my steps, halfway to my kitchen.
what my patients in the ER were feeling.
I’d had no
~ ~ ~
It was a
moment of intense revelation in a year of profound
revelations, a year that has completely changed my
practice as an ER nurse.
terrible things in Sierra Leone. I saw adults die,
bleeding out slowly in the dark, cold and alone.
I saw children die, locked with seizures. I saw
mothers holding their infants,
watching their children die in their arms of
malnutrition, starvation, malaria, Ebola.
I saw some
of the worst suffering the world can inflict upon
months of work in Sierra Leone I quit my job and
flew to Belgium, locking myself away in a tiny,
medieval tourist town. I walked. I ate fresh fruit
and waffles. I slept. I walked some more.
respects I was extremely lucky. I did not suffer
nightmares, as did many of my colleagues. I did not
suffer debilitating panic attacks, or
hallucinations, or anything more than a mild culture
shock (I needlessly flushed the toilet a lot, solely
because I could, and took dreadfully, wastefully,
decadently long showers).
And as I
meandered the narrow cobblestoned streets one cloudy
afternoon, I happened to glance up at a series of
façades above some windows across the street. With
a start, I realized they were the Seven Corporal
Works of Mercy, the foundation upon which I
decided, long ago, to define myself as a nurse.
I stared up
at the carvings for a long, long time.
~ ~ ~
realized that day is something I’ve struggled to
articulate for the better part of a year. It is an
awareness broken into two separate pieces.
majority of the humans I meet for the rest of my
life, especially here in the United States, will
never attain awareness of the type of suffering I
bore witness to in West Africa. Here, isolated on
our enormous, relatively homogenous, monolingual and
tremendously wealthy continental island, we will
likely never be subjected to an epidemic that leaves
us dying by the hundreds in the street, or to
starvation so severe our children die in our arms.
Most people here will never have this awareness
because they cannot acquire it
ways, this is not their fault; it is instead a quirk
of geography. And luck.
without visceral awareness of global suffering, the
only suffering people can comprehend is their own.
And without a wide barometer, an ingrown toenail
becomes a situation for tears and a panic attack. A
three-hour wait to be seen becomes “medical neglect”
and a threat of a lawsuit. A refusal to refill a
“lost” narcotic prescription becomes “deliberate
reactions are clearly out of proportion – but the
only awareness people have of suffering is their
teach someone the relative degrees of suffering.
you must understand them on their own level.
~ ~ ~
haven’t articulated this well. I may never be able
to. It is incredibly frustrating when my words fail
“annoying” parents in room 30 are very young,
uneducated, and frightened because they don’t
understand why their infant is crying. They are
annoying because they love their child.
is love annoying?
in room 21 doesn’t want to get sober, or get off the
street. He smells terrible and always asks for food
and juice. But he drinks because whatever he has
endured in his life is so painful that it is better
to be drunk and homeless than sober and in despair.
is despair a reason to mock someone?
in the wheelchair in room 9 speaks with a broad
southern accent, and doesn’t understand how her diet
affects her diabetes, and why her blood sugar is so
high. She never finished high school, and cannot
read above a fourth-grade level. The tech mocks her
accent within the patient’s range of hearing.
is a lack of education a reason for cruelty?
~ ~ ~
It is naive
to believe that an ER can run solely on niceness,
and I do not harbor such naiveté. We face patients
who are violent, cruel, rude, threatening,
manipulative, and simply dangerous. We are mandated
to save the lives of humans who have willfully
killed other humans. We are hit, kicked, spit on,
pissed on, shat on, and verbally and sexually
be nice to everyone, or we would lose our minds.
does not mean we should be unkind to everyone in
~ ~ ~
revelation about the relativity of suffering, first
planted on a cold sidewalk in Belgium and nurtured
over the past year, has changed me completely. The
temper that flared and raged in me is almost gone.
Just…gone. I am kinder to my patients. I am
fortunate enough to work in an ER where I can take
time to listen longer, ask more questions, do more
I am far
from perfect, and I mess up and get frustrated every
single shift I work. But I am no longer angry, or
cruel. And I work with, and have worked with,
nurses and doctors who are cruel. One particular
physician is so burned out that he leaves his
patients in tears, every shift.
Just as I
cannot teach my patients the relative degrees of
suffering, neither can I teach it to my coworkers.
But I can take this awareness I bought, at hard
cost in the jungle along the equator, and pay its
dividends to every human that I can, to every
patient I have the privilege and duty to care for.
brings me back to pain.
frozen in the hallway, partway to the kitchen,
hurting, desperate for a cup of coffee and some
thought, holy shit. This
is what pain means.
that life suddenly stops. Life is you knew it, as
you liked it, as you wanted it, has changed.
Sometimes it changes for a few hours, sometimes for
a few days, or two weeks. But sometimes it changes
you can’t think, you can’t concentrate. You can’t
study for your certs, or read your fascinating but
complex book from the library. You can’t even focus
long enough to write a thoughtful e-mail, or make a
reasonable phone call. Pain is so distracting that
you are reduced to being simply an observer, a
seven-hour-watcher-of-YouTube, instead of a
participant in your own life.
becomes the central focus of your world, the only
thing that matters. You will do anything to get it
to stop. You will take some of the strongest, most
dangerous drugs in the world, drugs that make you
vomit, make you stupid, make you constipated, make
your lungs slow down to lethal levels, to get it to
want it to stop.
of pain, and how we treat it in the US, is so much
more complex than I care to address here. It ties
to the failures of our tattered healthcare system, a
opiate epidemic that is decimating communities and
exhausting emergency responders across the country,
a national culture of blame that refuses to care for
our most vulnerable populations.
least for me, it unlocked yet another door to help
me better understand my patients.
My pain, at
its very worst, was maybe a 7 out of 10. I have
never experienced 10 out of 10 pain. I hope I am
fortunate enough that I never have to.
will stop eventually. My life will resume as it was
before, probably even better than it was. But the
empathy I gained, though again bought at cost to
myself, is priceless.
without empathy, or even simple sympathy, we no
longer see our patients as humans.
moment we no longer see the human beneath the pain,
the drugs, the booze, the broken leg, the heart
failure, the obesity, the anxiety, the condition
that has brought them to our door in the middle of
the night — that is the moment we are no longer
And that is
the moment we need to walk away.