Beneath the Sun

"Your baby is getting her organs," he whispered into my ear. A phrase that both stopped and started everything.

I rushed to finish ICU rounds, and our bleeding, orange baby blew kisses at us and waved to her people from the confines of her glass room. "It's my day!" she seemed to say, giggling, and burring her face in her mom's blood-stained top.

There was some healthy competition as to who would get to go on the organ procurement. I was persistent and forceful, and later found myself in a posh jet with two of the most well-known surgeons at our hospital. I was pretty sure they had hired Air Force One to fly us. I munched on the goodies from the console and looked out the window at the setting sun.

The surgeons were tickled pink to have someone to harass the whole flight. "Are you going to throw-up, Danielle?" one of the surgeons taunted. "Because if you do, we are not letting you scrub in, you'll stink up the OR!" Ha ha ha. Oh, manly surgeons, you are so strong and funny.

"No, I said. Oh, and I brought a step-stool for you, so you can actually SEE the sterile field."

They leave you alone, if you can give it right back to them.

The transplant coordinator gave me a stack of papers to read. Papers about the donor. A baby who was not loved so much as ours. At least not in the moment of mortal rage.

We arrived at the hospital and were whisked away to the operating room. The donor was already on the operating table--tiny socks had fallen off the bed and been tossed into the corner, near the other discarded things. I watched as teams from all over the region came and did their part--cutting, tying and taking away. I had not forgotten how the bovie smells...it always smells the same. And never, ever will I get tired of seeing the heart beat inside of the chest, or the bright pink lungs rise and gently fall, like a well-controlled balloon animal at a child's birthday party.

Hours passed too quickly, and no one could say anything, as we waited for the OK that the organs would be healthy enough.

But I knew they would be. I had seen them, and they were gorgeous. I wondered if our baby's mother would ask me about the donor, and what I would say if she did. Could I tell her that the baby was beautiful, and just the right size? Would she want to know what happened? I practiced the art of not saying anything, because I knew that was what would be required.

And when all the teams were done, and tiny organs were in tiny bags, divided up for tiny people, the anesthesiologist turned off all the machines and drips and walked out of the room, while texting on his Blackberry, leaving behind an empty, open shell of a baby.

"Well, what did you think?" one of my surgeons asked me outside, as we zipped up our jackets before hopping back onto the plane.

"That was AMAZING!" I said. "Do you not have the coolest job in the world?"

He sighed, and rubbed his head. "Yeah, our baby deserves her chance, for sure. But man, that kid didn't deserve that...what we did to him in there."

A statement which I can't quite get over.

The transplant coordinator called back home, and said our giggling, happy girl was rolling into pre-op. We ate a hot meal on the plane ride back, and I kept a good eye on the cooler carrying our loot. I looked at my pager and was shocked at how late it was, because I didn't feel tired at all. I gave one of the surgeons my dessert, for the long surgery he had ahead of him. He looked tired, and I tried to contain my excitement.

Some days, I love my job.

We finally arrived home, and I dropped the cooler, and my less-feisty surgeon friends off at the OR front desk. I was in a hurry to get home, because I had to be back at work in just a few hours. I didn't go see any of her surgery, figuring I would see her in a few hours anyway.

I drove home tired and content, but mostly in awe. And someday, when someone else gets to do what I have done, I will hold their face in my hands and tell them sternly, "Remember this. Remember what this feels like."

I want this to be where the story ends. How one baby's senseless death gave life to an equally wonderful, bleeding little girl.

My phone rang as I was brushing my teeth. It had only been twenty minutes, so I wondered if I had forgotten to tell them that I wouldn't be scrubbing in. I really thought that.

It was my friend who was on call in the ICU. "Danielle," he said, "I am so sorry..."

I sat on my top step and calmly listened to him tell me how they had opened her up, and how she bled ferociously. They pumped blood into her and massaged her heart. Her brand new organ sat in a tub of ice beside her, waiting. Wasting.

There is so much more. So much more about her happy demeanor, and sweet face. There is more about her mom, and an unfinished life. There is more on wasted organs and wasted lives and thoughts about how futile and disgusting that whole night proved to be. But mostly, there is just no one blowing me kisses anymore.

I have been waiting for someone to try and tell me how "all things work together" or how I can't see the "bigger picture." Please. Try. Try telling me how this wasn't something absolutely wasteful and pointless.

After hearing the news, a friend and fellow resident said the first and only thing that has made any sense to me. One sentence, no reasoning or philosophical metaphors.

"She was a wonderful baby."

Yes, she was.


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Now playing: Chris Castle - Of God and Man (Beneath the Sun)

Maybe Mylicon

As a senior resident now (what? hold the phone...yup, it's true!), I am rotating through the Neonatal Intensive Care Unit (NICU) for a second time, but this time I am carrying patients with a higher acuity--on ventilators, very small, not taking any feeds by mouth. The "feeder-growers" working on nippling are left for the interns.

My intern called in sick, unfortunately, and I had to pick up a few extra feeder-growers. When we got to a 36-weeker who was just about to be discharged, the Attending asked me why the baby still had her NG (feeding tube) in. I told her that the baby had been having a lot of gas and air in her belly, and the nurses were using it to decompress the stomach. All very fancy, right?

"Remove it." she said.

"But..but..wait! I am uncomfortable with that. What if she gets gas in her belly again? How will we get it out?" I whined.

"You can pick her up and burp her."

While she is bleeding.

A few months ago, I took care of an adorable toddler who is awaiting a liver transplant. Back then, she was a slightly florescent version of Buddha. Wearing Carters.

The transplant team made of video of her, showcasing all of her toddler talents, to play during her plea for an organ. She smiled and blew kisses. She clapped her hands and took a bow.

Recently, she came back to me. Her mom waved me down, excited to meet again. Feeling known.

My bright yellow Buddha was even more orange, but also black and blue and purple. With her liver absolutely shot, and no function left whatsoever, she was bleeding uncontrollably. Blood was pouring out of her nose and around all of her IV lines. Her dress was completely saturated and her room looked like something out of a horror film. It was dripping down the side of her hospital crib, on her toy piano and smeared across the wall. The nurses were hanging bag after bag of blood product, cleaning it up off the floor almost as fast as it was going in.

All the while she was laughing, clapping and batting her big eyelashes.

I was completely shocked at how absolutely horrific the scene was, and amazed that her mother, and everyone else around her, seemed so unbothered by the sea of red they were sloshing through.

And as I looked down at her, sitting cross-legged on her saturated sheets, looking up at me with blood caked across her chubby cheeks, I thought about what love does to us. How it allows us to look at THAT and still see HER, our beautiful, hilarious baby. To see through the crusted mess, and sort of forget about it, when she blows you a kiss. Love allows us to wish so hard for something to come true, that we can be OK praying for another child to die, so that ours will live.

Love is not clean or safe.

Why does she matter? Why should she get this liver we all beg for? Who else is praying that it's their turn? I think about all these things, and many more, while she bleeds and we love on her.



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Now playing: Bebo Norman - The Man Inside
via FoxyTunes

Rituximab. It's a British Thing.

In my half-asleep, half-awake 2-week stupor, I have had moments that say to Laughter: "Inappropriate, but come out anyway!" To which I suddenly, alone, burst out into giggles on rounds. Everyone looks at me as I stand there wiping away Laughter tears and shaking my head in disbelief that I can hate my job and love it all at once.

An impatient consulting attending of British descent sat plopped in a rolling chair, right in front of our sickest patient's room. A resident of Spanish descent struggled over some difficult to pronounce words in his presentation. He kept saying "biweekly" when he really meant "twice a week."

After some loud, obnoxious sighs that sounded like Queen Elizabeth II herself judging humanity, she finally stood up, threw her arms in the air, and said, in her most British and exasperated accent, "Mr. Sanchez, this is my language and you are absolutely butchering it!"

Little Bird

Working in the Emergency Room is a frustrating experience, in the sense that the large majority of what comes through the doors is a complete misuse of resources. I found myself jaded and more unhappy than I had been in ages. But healthy kids are fun. And it's impossible for me to be mad at a 3-year-old. So even when I didn't believe in what we were doing, I could at least believe in him.

Healthy, snotty 3-year-olds whining in the waiting room paints a blithe background for tragedy, when it does roll in the door. And after she has passed, I hand out stickers and Popsicles and truly thank God for their tiny, sticky, healthy hands.

EMS calls in, and the static over the line only adds to the presupposition of chaos on the other end. There has been a car accident--two adults and a child. The two adults were dead on arrival, but the child, a girl, unknown age, had a pulse. At least initially. Somewhere along the road, they had lost that, she was intubated (breathing tube) and they had been doing chest compressions for twenty minutes. When she rolls in the door, no one knows her name, or anything about her. She looks to be about six. Things move fast, but she lies still. Chipped, pink fingernail polish is scrubbed off. Ribs break, heart doesn't beat. The Emergency Room attending asks for silence, as an ultrasound shows no cardiac activity and then asks, calmly, if anyone has any objections to stopping. It's been a very long time, though it feels short. Lines and tubes are removed, her face is cleaned, and she is tucked into a sheet and taken to an exam room. We wait to find out her name, and who will claim her.

A mother steps out into the hallway and asks me how much longer it is going to be before I have her prescriptions ready. Like I have been doing paperwork or online shopping and neglecting them.

And as sad as we are that the little girl has died, there is some sort of strange comfort in knowing that her parents died too. That they don't have to live without her. It's a large tragedy, so we think, that somehow could be worse.

Until a disheveled, working mother shows up, after hearing of the accident. I don't know who the adults were in the car, if one was the daddy or grandma. Maybe they were older siblings or babysitters. But one of the adults in that car was not the little girl's mother, because there she was, standing at the counter, asking about her baby girl. "Was she in her car seat?" she asks, which I find so incredibly sad.

I am certain that the end of the world will sound like the deep, mournful cry of a mother who sees that her child has died.

And at the end of it all, she thanks the nurses and chaplain. She wipes her eyes and asks if she can donate some of the little girl's things to the hospital. That morning, she woke up, had a healthy child and normal life, but now she will walk out of the hospital with nothing. How do you come back from that? I would be angry and hateful and broken.

I am the impatient woman tapping my foot, angry for sickness and delay. Oh, to instead be the devastated mother who says, "This is the worst day of my life, but still, I am grateful."



Now playing: The Long Way Around -- The Dixie Chicks
via FoxyTunes

A Year in Songs

What I've been listening to this year, by month. The following is a collective of my inner soundtrack. Just a few simple clicks and you are inside of my brain. Weird.

January 2009
All the Young Dudes - Mott The Hoople (Amazon.com)
Be Gentle with Me - The Boy Least Likely To (MySpace Music)

February
First Day of My Life - Bright Eyes (YouTube video *love*)
Never Say Never - The Fray (Official Site)

March
Come Down To Me - Saving Jane (Amazon.com)
The Chain (Live) - Ingrid Michaelson (Official Site)

April
Go On Say It - Blind Pilot (Vimeo *Oregon!*)
Jenny Lewis with the Watson Twins (Team Love) *can be explicit. you've been warned*

May
Say It All - Sondre Lerche (MySpace Music)
Everything ever recorded by Joshua Radin (Official Site)
Wagon Wheel - Old Crow Medicine Show (Official Music Video)

June
Sunshine - Matt Costa (Official Site)
The Give Up Album - The Postal Service (Sub Pop Records *Ben married Zooey, sigh*)
Fireflies -Ron Pope (MySpace Music)

July
A Hundred Billion Years - Chris Castle (YouTube)
Halfway- Sandra McCracken (Music City Unsigned)

August
Ellis County - Buddy and Julie Miller (Official Site)
Two Hearts are Better Than One- Katie Herzig (Myspace Music)

September
Far, Far - Yael Naïm (Official Site)
El Salvador - Athlete (YouTube)

October
Wake Up - Arcade Fire (Stereogum)
Everything about Ingrid!! Oh, where do I start? How about here. And here again.

November
Let the Distance Keep Us Together - Bright Eyes, Britt Daniel & Spoon (Buy this. Really)
All of My Days - Alexi Murdoch (YouTube)

December
Masterfade - Andrew Bird (Listen here.) Oh..and seeing him live made me wonder if that's what it might feel like to get high
Us- Regina Spektor (Official Video)


It's been great, 2009. Thank you.

What's inside YOUR brain?

Best Quote of Christmas Eve

ER Attending to a Resident:


"Wait, so did the kid eat the candied yams before or after he touched the reindeer?"




Now playing: Elf's Lament -- Barenaked Ladies
via FoxyTunes