Loneliness, she mused, is like hunger; it isn’t outside but inside oneself. To be lonely, she thought, is to sense that one lacks something, something vitally necessary, but what she knew not.
–from Musashi, by Eiji Yoshikawa.
And in our hunger, we reach for each other.
We grab our friends by the wrists and drag them onto the dance floor with us, unwilling to let the music encompass us solo. We meet them in airports and train stations and harbors to travel enormous distances, intent that the sights and sounds and smells and tastes we experience will be shared.
We sort through half of us all, considering, rejecting, inviting. We send out tiny electric tendrils across cities and borders and time zones like gossamer nets, our phones and laptops busy at harvest. We celebrate humbly and lavishly and simply and wildly when two of us decide to stop casting our nets for anyone but the other.
But it is the end of ourselves that, paradoxically, drives us forward throughout our lives, a fear so deeply buried and embedded that to articulate it seems tantamount to surrender. In a society that urges us to be strong, to be independent, to be our own person, our greatest fear seems to be the ultimate expression of weakness.
It was many, many years ago in Boston that he and I sat in a dark corner of the bar, empty shot glasses a shimmering thicket before him. He lay his head and arms on the table and curled his hand over his eyes, weeping within an intoxication so black and heavy that it would relieve him, in the morning, of any recollection of the conversation.
“My God,” he said, sobbing, “I just don’t want to die alone.”
~ ~ ~
The ice storm persisted, unhurried but undiminished, for three straight days.
I lived less than a mile from the hospital, but I started the car an hour before my shift and cranked the heater up full blast. After a solid fifteen minutes, the ice coating my windows had melted just enough for me to be able to laboriously pry it away, scraping and scratching. My drive to work was at a pace no faster than a walk.
We were caring for our usual assortment of Northern Winter Storm Maladies – broken wrists from slips and falls, exercise-induced heart attacks from vigorous shoveling, neck pains from slip-n-slide fender benders and attacking telephone poles. But the ice on the roads kept most everyone in the state inside, and it was quieter than usual.
The nurse came up to me as I sat at my desk, idly leafing through yet another certification practice test. “Can you come look at something for me?” she asked, quietly. I stood and followed her over to one of the rooms designated for critically ill patients.
The woman in the bed was old, her hair leached of color by the decades, her face leached of color by the harsh fluorescent lights of the room. Her eyes were closed, her hands resting gently at her sides, a blanket pulled up to her waist. She was so peaceful that she could have been sleeping, save for the profusion of IV drips sprouting from the inner aspects of both arms, the multicolored cords snaking up from the neck of her gown to the monitor on the wall, and the endotracheal tube between her teeth. The ventilator next to the bed inhaled and exhaled for her with soft, endlessly rhythmic sighs.
“What happened?” I asked.
“Huge hemorrhagic stroke,” the nurse replied. “She was playing cards with her friends at the retirement home, complained suddenly that she didn’t feel well, and then she laid her head on the table and never moved again.” She pressed her lips together tightly, and I recognized the subtle expression of sorrow I’d made myself more than once in the ER.
I nodded. The woman laying in the bed in front of me was already gone. She was not dead, but the person she had been, her memories, her thoughts, her fears, her loves, all of her very self had been erased in an instant. “Any family?”
“A nephew in the city.”
“Ah,” I said, suddenly seeing the situation in a new and terrible light. “He can’t get here in time, can he?”
She shook her head. “It would be suicidal for him to drive on these roads, and he knows it. The doc spoke with him for a while, and he wants us to honor her directives sooner rather than later. I’m just waiting for respiratory to get here, and then we’ll extubate her and let her go.”
It was the right decision, and a compassionate one. I was impressed and moved by the decision of the nephew, trapped in an icy city four hours away. I glanced at the other nurse. “So what did you need me to look at?”
She met my eyes, and I was surprised by the flash of panic I saw there. “I’ve never done this before.”
My jaw dropped. “Never?” I asked, incredulous. The ER where I was working was busy, almost daily, with critically ill patients.
“I mean, I’ve seen people die before during codes, when they’ve crashed and we can’t get them back. But never like this. Not when I know it’s coming.” She stared at her patient. “I don’t want her to suffer.”
“She won’t,” I said, firmly. “You won’t let her. And I’ll help you.”
~ ~ ~
We hung IV medications for sedation and pain relief. We placed a small patch behind her ear to dry up any secretions in her mouth and throat. We took off the pulse oximeter and the blood pressure cuff, and shut off all the alarms on the monitor. All that was left on the screen was the constant, simple green tracing of her heartbeat.
The RT arrived and, after a bolus of meds from the IVs, stopped the ventilator and pulled out the breathing tube in a smooth, easy motion. He nodded at us briefly, unplugged the vent, and wheeled it out of the room, his mind already on his next critical patient of the night.
We knew from her head CT that the bleed was so large that she would never again breathe on her own. All the critical functions that sustain life had been destroyed in the initial injury. Eventually, now that her blood was no longer being artificially oxygenated, the tissues of the heart would eventually seize and die from the lack, and then it would be over.
But the heart – for lack of a better phrase – has a mind of its own. The muscle cells that form that big tireless pump in our chest move in their own intrinsic beat. They’re willing to work with other stimuli from the body — they will speed up when we’re startled, slow down when we’re relaxed — but in the absence of any other messages, they’ll just do their thing, beating, beating, beating, until they can physically no longer do so.
We watched the monitor for a few moments. Her heart kept beating, unconcerned, determinedly following its own directive.
The other nurse quietly reached for a stool, and sat on the right side of her patient’s bed. She took her right hand.
I pulled the trash bag out of the trash can, flipped it over, and sat on it on the left side of the patient’s bed. And I took her left hand. It was cool, pale, soft. Empty.
We sat there together, neither of us speaking, neither of us needing to. We could hear the muted buzz of the ER outside the door of the room, but in that moment, deep in the night, our hospital draped in the deadly glitter of the storm, we three were alone in the world.
Her heart slowed down, confused by the lack of oxygen. Then it raced ahead, a rapid fluttering tattoo to try to compensate somehow. Then a slowing. And then a pause. Then a normal beat. And then another pause. Stubbornly, unwilling to relinquish its raison d’être, it persisted, a burst of beats here, another long pause following.
We sat at her bedside, holding her hands, waiting patiently.
~ ~ ~
It was a rare moment in my career, one of deep serenity. It was a time out of turn, a time of stillness and grace, of bearing witness. I would be reminded of it years later, suddenly and unexpectedly, as I stood on a western slope of the Sierra Nevada, surrounded by a stand of giant sequoias.
It was late afternoon, and a watery sunlight filtered through the trees, divided into beams by the massive trunks scattered about me. It smelled of earth and cedar, of woodsmoke from the nearby campground. I craned my neck backwards and squinted at the tops of the trees, lost in the distance of an endlessly blue sky.
I realized that I was in the company of the largest living things on the planet, larger than the largest whales hidden in the depths of the ocean. A dozen of them stood sentinel around me, silent in the way of giants, words unnecessary in the presence of an enormous overwhelming existence.
And it was there in that warm California evening that I suddenly remembered the ice storm, and our bedside vigil. And in the perpetual adoration of the grove, I suddenly knew with calm certainty that, for the first time in a long time, I was no longer hungry, and I was no longer by myself.
~ ~ ~
The door of the ER room opened quietly. A third nurse poked her head in the room, a concerned look furrowing her brow. She saw us at the bedside, and her gentle features relaxed.
“Good,” she said, without waiting for us to speak. “I’m glad you guys are here.”
“What’s up?” I asked softly.
She shook her head. “Nothing,” and then gestured to our patient. Compassion shone from her eyes.
“I just wanted to make sure she wasn’t alone.”
Beautiful, thank you.
You write beautifully.
I was (am?) a neuro nurse and spent most of my bedside career working ICU. I’ve watched this scene played out many times in the 18 years that I was at the bedside.
I’ve seen too many ugly deaths – the codes, patients whose families want us to “do everything!”
I’ve also been privileged to have witnessed many beautiful deaths, like the one you described here.