Morning Fog from the Fifth Floor

 

Yesterday morning the fog sat full on the head

like a bowler pulled down to ears and eyebrows.

I experienced it from the fifth floor of our building

looking out over roofs and treetops... a tower.

The clouds, unable to fly high, rested on the earth

where I breathed in their cool air and water vapor.

It was womb-like in the lack of light, enveloped by 

moisture, and hearing the heart beat of Our Mother.

I am a fish out of water in so many ways, having 

lost the routine of moon cycles and predictable waves.

I am too dry, not sure why, wanting to cry and water

the earth with repentance, to regain reconciliation.

Yesterday morning the fog sat full on my heart,

heavy hands rhythmically pumping up and down,

like a code had been called in this hospital on the 

fifth floor to try and bring me back to life.

***

A View from Above

 

The huge wrap-around windows in our Neuroscience tower offer a view of the Columbus cityscape off in the distance.  

This is especially true from the 9^th floor where I was seeing a patient today.  It always gives me pause, to stand and look out.

It reminded me of a recent conversation with my son who is a junior at the University of Dayton.  He in a sort-of existential phase.

He shared how wonderfully strange it is that thousands can live in a city in close proximity, all with their own unique lives.

In a very real sense it is a multiverse of beings who are physically self-contained but spiritually interconnected and intermingling.

I remember those days in my early 20’s when wider views and deeper thoughts shook up my small town perspective, changing me.

Exit Signs

 

Life is a long 

hallway from 

birth to death

that we walk

oblivious of its 

finite distance

exit signs like 

highway markers

a fair warning. 

***

Leaving Grant

Tomorrow the photos on the bulletin board at Grant Medical Center come down after spending the month of February on display.  During that time I have flip-flopped week by week from Riverside to Grant, Grant to Riverside, and back over the past few months in transition.  April will see the end of that and I’ll be full time at Riverside after a fifteen year run at Grant.

Those photos are a glimpse of my time there.  They are the beauty that I saw in the people and the environs day by day, season by season, year by year.  It’s appropriate that so many of them are funny and quirky alternating with images that are beautiful and melancholy.  They really are a visual summation of my time at a place I’ve looked forward to going to every single day.

Today was special in that four different people from four different parts of the hospital stopped me and specifically mentioned the board and what photo most spoke to them.  They included an ICU nurse, an elderly maintenance man, a Trauma NP, and a clerk all of whom I’ve known for years.  There was a kind of sparkle in their eyes as they described what they saw.

The maintenance man was particularly moving.  We’ve had brief moments of interacting over the years in the hallways and he always radiates kindness.  He stopped me and told me how special those photos were and his favorite was the one with “rain drops on the window”.  He said he wished he could do something like that and I had the “eye of an artist”.

I think it hit me so deeply and unexpectedly because that is exactly what my godson Kevin had said to me years ago before he’d passed.  He was an actual artist and it had shook me up then and even more so now.  This sweet man had seen something of what I’d tried to convey through creative outlets: expressing feelings of beauty, kindness, sadness, and love.

And tomorrow those photos come down and a little more than a month from now I will no longer be going to Grant as my day to day job.  At this very moment it is like nothing is different  or has changed because I am still doing the same things and talking to the same people this week enjoying their company until that day when it is not pictures going away, but me.  

***

The Blues

 

The Blues sing to the soul

in deep emotional hues.

A transcendent force like 

taking the stairs by twos.

It is a melancholy medicine

healing with tragic trues.

A magnificent temple of 

worshipers empty of pews

(there can be no sitting 

when there’s so much to lose).

***

Fearful Symmetry

 My heart stays hidden 

in a small brick tower 

of fearful symmetry…

…afraid to face a world

that ignores my wishes 

even if they are selfish.

***

The Statue of Psychiatry

 

Give me your tired, your poor, 

Your huddled masses yearning to breathe free

(Grant is a smoke free environment) 

The wretched refuse of your teeming alleyways. 

Send these, the homeless, tempest-tossed to me, 

(single file through the metal detectors)

I lift my coffee cup beside the golden door!

***

Hidden Oceans

Hidden oceans and depth of sky 

within each person we pass by. 

Doors may open to pour it out 

waves of pain, clouds of doubt. 

Stand your ground and let it flow

we need each other to fully grow.

***

“Where the Ditches are Deep”

This was a fascinating case I saw in the hospital several years ago of a man in his 30’s who had no previous psychiatric diagnosis, but had likely suffered from a psychotic illness complicated by drug use for most of his adult life. He was unique in the sense that he used drugs to see “real things” which to me sounded like hallucinations and paranoid delusions. When these types of things occurred apart from drug use he took that as further proof of the objective existence of the things he was seeing and experiencing. It was enough that he was perceiving them for it to be true and in the story below he seemed to suggest that other people saw these things too.

***

In his own words: 

When I was a little boy my mother would invite people over and do drugs with them in our house. They would start acting weird. One guy would be peeking out through the curtains and say “there’s someone out there.” Another one would be on his hands and knees trying to pick things out of the carpet. I wanted to know if what they were seeing was real. So when I got the opportunity as I got older I started using all kinds of drugs to try and see what they saw. I was not trying to get high. I wanted to see for myself if what they were seeing and experiencing was real. I want to tell you about something that happened to me so you will understand.

I was in a barber shop with some friends, well it was a tattoo shop, and Homey had some spice. He took a hit and then passed it to me. I took a hit and then passed it to Walter who was applying a tattoo to a woman customer’s leg. He then passed it back to Homey. Something changed and I saw Walter’s face looking down in shock at the work he was doing as the tattoo lifted off her leg and evaporated like smoke. He was real shook up and laid down his inking gun. He left the shop quickly and I followed him because I had seen it too. It was real. I found myself outside in a dark place where the ditches are deep.

I walked down the street and turned right at the corner. From there I could see my Grandmother’s back porch and my uncle was sitting on it. As I approached he was looking at me but not saying a word. The door was open next to him as if he were waiting for me to go in. I walked into the house and it felt like a dark form had followed me in. My Grandmother became upset and said, “What did you bring in here with you?” I suddenly felt like I was a little boy again and was in trouble, like she was going to spank me or something.

Then I noticed her little dog and I saw it transform into a snake creature and rise up. It came at me and I put my hands together like a fist and smashed them down onto the floor. The mirror, a glass coffee table, and the picture frames on the walls shattered from the force. It was real. I saw it myself. My uncle grabbed me and tried to hold me, yelling “What is wrong with you?!”

***

The most striking thing for me in this story that he told was his description of the dark place where “the ditches are deep.” This seems to me to be a telling metaphor of someone struggling with mental illness - whether depression, anxiety, or the inability to distinguish reality from unreality. In my psychiatric residency at Walter Reed it was described to me by a young African-American woman on the inpatient psychiatric unit who said it was like being trapped in a nightmare where “I don’t know what is real and what is not real.” Everyone goes off the road at times but for some the consequences are significantly more catastrophic. The ditches are deep indeed.

The Transcendence of Transitional Objects

He's a middle aged man with gray streaks in greasy hair, smudged glasses, a bit of a paunch, and lying in a hospital bed. The medical chart indicates he carries the diagnosis of "Schizophrenia" and other superficial details that tell me little of the man. I am surprised to find he is talkative and eager to engage, not typical for someone so labeled. I notice something peculiar.

He shares his bed with two teddy bears he has brought from home.  His voice and mannerisms are childlike and in sync with the company he keeps.  I begin my interview with an observation,  "I see you have some friends with you".  He lets me know that his mother discouraged him from bringing them to the hospital, "but I'm lonely and they help me feel good."  I nod sympathetically.

He takes one of the bears and hugs it tightly with his eyes closed.  "When I feel bad or lonely I do this and say 'please hug me Jesus through this teddy bear' and I believe He does."  There's a disarming directness to it.  I then remember his chart mentioning "terminal cancer" and tears well up threatening my composure, leaving me lost and looking for a transitional object of my own.

***

What do you see?

 

A circle, a line

a cross, a shadow.

A loop of loops

a red tube and arrow.

I see beauty where

beauty has no

business being, but

that’s what I’m seeing.

***

The Cubicle

 

I saw her in her cubicle in an adjacent building on a Friday and then out in the main hospital on a Monday.  They are connected by a hallway, an elevator, and then another hallway that passes by my office.  An image came to my mind unbidden: She is in a four-sided cubicle with high white walls that reach nearly to the paneled ceiling.

She works dutifully until the proper time arrives and a white door-sized panel slides upwards releasing her to enter the maze of the hospital.  She interacts with other employees and each time her job is done correctly another sliding door, smaller than the first, opens nearby to reveal a tasty snack.  This motivates her to continue.

And in this metaphor I see my own wanderings in the hospital up and down stairs, zigzagging through hallways, and in and out of rooms in what amounts to a fabulous gerbil city that confines me throughout the workday in its squared tunnels.  I smile and say “Hi” a lot because happy gerbils are productive gerbils (and vice versa).

***

The Power of Thin Mints

 

There is something undeniably powerful about a Girl Scout cookie thin mint.  Today I saw a nurse’s assistant come into the 6th floor work area with an armful of those lovely green boxes and I made comment about how much I love them.  She offered to sell me a box from her limited supply but when I told her I had no way to pay her she said I could pay for it when I see her next. 

That’s when the Nurse Manager swept in and bought a box for me despite my protestations.  It was an act of kindness that I wasn’t sure I deserved and it made me a bit verklempt.  It  became clear to me in that moment that I would be remiss if I did not share this windfall with others in this place that has been so good to me over the years.

I quickly took on the role of a thin mint street dealer by hiding the box in my inside jacket pocket and sidling up to people with a whisper, “Hey, you wanna thin mint?” and giving them only the slightest glimpse of the green box.  The smiles were worth a lifetime supply of thin mints and by the time I was headed out the door for the day I’d eaten about four and given the rest away.

To be honest, I don’t know what came over me when I was handed that box of cookies.  My inclination was to hurry back to my office and eat them in the dark like Gollum on his island in the cave with his “Precious”.  But there are few things more precious to me than my coworkers at Grant Medical Center.

***

Lucky Ones

 

Snow falls from unfathomable heights

filling the sky with white points of light

floating and flitting at the wind’s whim.

Here in the sad city it is something to see,

nature’s invasion of stone and steel,

we lucky ones watching from windows.

***

Palliative Care in the Space Age

 

The simple hydrogen engine was thrumming underneath him pulling him down into the stasis couch like a full-bodied hug.  Or was it pushing him?  A domed screen above him perfectly projected what lay in front of the rocket so that it appeared he was at its tip piercing the sky.  The clouds that hung lazily in the distance had started as white patches but were quickly becoming massive banks of floating white fluff.  With barely a blink and a sigh the rocket punched into it and everything became a soft white glow.  

Much too quickly he came through the other side and the pale blue sky began purpling as stars began to speckle his view.  The music surrounding him had been chosen to match the majesty and finality of his experience.  After some pre-launch deliberation he had picked Sigur Ros as well as the smell of crushed dandelions.  It was a multi-sensory experience and the idea for dandelions had come from his boyhood when all seemed right with the world and he’d plucked them, rubbed them tightly between his thumb and forefinger, and breathed them in deeply leaving a yellow stain on his nose.

These were his final minutes at the cusp of multi-organ failure and the slow infusion of a sleep-inducing formula that was almost imperceptible in its conscious-dampening diffusion.  He felt at peace with himself and with the expanding universe.  It was like a head start to heaven.

***

The Hospital at Night

 

The golden glow 

of the hospital 

at night 

passed on my 

drive home 

to the car’s right.

I imagine seeing

suffering eyes 

without sight

where attempts 

to breathe 

are a losing fight.

***

The Publican & the Pharisee at the Hospital

I heard it come from a nearby hospital room as I sat at the nurse’s station writing a note.  It was a man’s voice that was a little gruff saying “Well, are you saved?  ‘Cause I am.”

It piqued my curiosity enough that I got up and casually walked by the room to see what was going on.  The man who asked the question and made the assertion about his salvation looked to be in his sixties.  He wore a baseball cap, hands on hips, and was standing over the other man who looked frail and weak sitting in a chair in a flimsy hospital gown, probably in his seventies or older.

The imbalance of power in what I was observing upset me.  My impression was that the confident man was visiting someone that he did not know well.  Maybe for him it was a perceived good deed or a felt obligation or simply an opportunity to air his ego.

What I did not hear was love.  What I did not see was humility.  It reminded me too much of the self-righteous hypocrisy I’d seen growing up in a small town.  We were the “saved” confronting the “sinners” because they needed something we had.  A something not informed on any deep spiritual level, but an idea in our heads and a false confidence sustained by the liberal use of denial.

It suddenly felt like I was witnessing a reenactment of the parable of The Publican and the Pharisee where the haughty one stands in front of the temple thanking God he is “not like this Publican” and the humble one stays hidden in the shadows imploring God “have mercy on me, a sinner.”

***

Pebble in a Tin Can

A tin can came rolling across the road blown by the wind causing me to swerve to avoid crushing it on the way home from the hospital.  It got me thinking about the patient I’d just seen, blown into my path as it were by way of a psychiatric consult.

She was in her mid-twenties, admitted for a large abscess on her arm from shooting heroin.  She was showing signs of premature aging after years of use.  She assured me she was a hopeless case, multiple rehab failures, never able to finish a program before being kicked out.

She was abrasive and sarcastic, quick to pounce on any stutter or redundant question with ridicule.  I felt the stings but left them unattended, not allowing irritation to enter my voice.  I would not be like most everyone else: caught up in her anger, frustration, and impotence.  I was there to help if I could.

My lack of responding in kind wore her down.  Useful information began to trickle out. Her first memory of childhood was of being raped.  Chronic insomnia, nightmares, and flashbacks from smells plagued her.  She used drugs to self-medicate when outpatient treatment was scarce between rehabs.  

Subtle signs of warmth began to escape from her at unexpected times, furtive glances becoming more sustained eye contact.  There was a connection forming on a basic human level, hope and love still in there echoing about, maybe even a bit of faith rattling around like a pebble in a tin can.

***

The Faith Mission Mirage

It is a testament to my time here that I’ve witnessed the slow changing of this fair (yet cloudy) city from the windows of Grant Medical Center over the past decade.

From the upper floors and looking directly north in my first few years here I could see the backside of a three story nondescript building that I thought was the Faith Mission shelter for homeless folks in this part of the city.  I would see its transient residents in our ER on a weekly basis and even up on the medical floor if their health had deteriorated to the point of needing actual hospitalization.  

A common scenario would be that they’d somehow managed to lose their bed at the Mission for a variety of reasons to include infraction of rules and so find their way to our ER with no other place to stay and the weather making sleeping outside uncomfortable if not potentially treacherous.  This time-honored strategy has as its linchpin the need to insist that one has “suicidal thoughts”, otherwise, without significant physical symptoms, one would be streeted in short order.

So this connection in my mind to the building in question continued even as they started to tear it down, eventually leaving a large hole in the ground after several months.  And that building-sized hole sat empty (except for a sizable pond that formed on rainy days) for at least a year or two before construction began to fill it up again.

I watched the new structure grow over the course of a two year period that started as an obvious parking garage for the first few stories but then transitioned into rooms rising another several stories.  It looked like a giant hive with its hollow spaces honeycombing the building and workers swarming in and out, up and down, with their bright-colored hard hats.

At some point in this timeframe my daughter began taking ballet classes five or so blocks directly north of Grant.  My wife was the usual chauffeur, but on one occasion I took her to her class and made a wrong turn a block south of the ballet facility.  The road dead-ended in front of a building which had people loitering about on the steps and stoop looking fairly bedraggled and bereft of a place to go.  Beside the entrance in large letters was “Faith Mission.”

So I was off by at least three blocks as to where I’d thought this place was located but correct about it being directly north of Grant.  The new building with its red decorative facade has turned out to be yet another swanky apartment building in this part of the city with several others recently finished or in the process of construction.  It seems rather ironic that a homeless shelter exists in the midst of a housing explosion.  I imagine a significant number of these unfortunate folks will continue to migrate down Grant Avenue when the Mission becomes unavailable to them and into our ER telling stories of wanting to “walk into traffic” but really only needing a place to stay.

***

Consolations

I hate being on call
on the weekends, but
if I keep my eyes peeled
and my heart is open
there are consolations.


***