Hope

A few minutes before the actual beginning of my Sunday morning shift, I was trying to hide out at a computer station way down at the end of the hallway so I could do my morning cleansing ritual, which requires the burning of a smudge stick while I chant "nam myo ho renge kyo" totally nude.

A ratty-looking patient stepped out the doorway of his hospital room and accosted another oncoming nurse: "When's my X-ray? First they said they'd do it in my room and now they say I have to go down for it."

Steven was polite and explained that he didn't know but that he would enquire.

"This is getting out of control," the patient muttered, "I'm gonna get out of here."

This gentleman was in his early thirties but he looked several decades older. He had come to the emergency room the night before complaining of chest pain and palpitations. So far his workup had shown him to have rather decent runs of ventricular tachycardia lasting a minute or two per episode.



He very likely was a candidate for placement of an AICD and it also would probably be good if he modified his lifestyle a bit. He looked like the sort of person who shot methamphetamine into his bloodstream while driving drunk. Maybe I'd seen him before on one of those police video shows on television.

A short while later I heard his dayshift nurse Sandra talking about how this patient had to be out of the hospital by 10 that morning. "He says he's got an appointment with his tax accountant."

"At 10 a.m. Sunday?!" I asked.

Sandra said that if the doctors didn't discharge him by then that he'd leave against medical advice. She already had the paperwork stamped up for him to do so. I said that was good and he'd be out of her hair.

The patient's wife showed up at 0930 and demanded discharge orders immediately. Sandra explained the situation, that the ventricular arrhythmia was potentially life-threatening, the workup was not yet complete, the cardiologist was already here and wanted to see the patient soon, etc. But the wife also went with the tax story.

They had already paid thousands of dollars in taxes, you see, and they had to see their accountant by 10 a.m.

Neither the patient nor his wife looked like they could afford laundry detergent, let alone large tax payments. But naturally, they left. Against Medical Advice.

Later our charge nurse said that the whole thing wasn't good. "It's too early in the day, and it's only Sunday. Sheesh, it's hardly begun and we've already had our Wanker Of The Week."

"Let's hope he was the one," said Sandra.

Yes, I hoped so too.

Sunday Early Plath

Female Author

All day she plays at chess with the bones of the world:
Favored (while suddenly the rains begin
Beyond the window) she lies on cushions curled
And nibbles an occasional bonbon of sin.

Prim, pink-breasted, feminine, she nurses
Chocolate fancies in rose-papered rooms
Where polished higboys whisper creaking curses
And hothouse roses shed immortal blooms.

The garnets on her fingers twinkle quick
And blood reflects across the manuscript;
She muses on the odor, sweet and sick,
Of festering gardenias in a crypt,

And lost in subtle metaphor, retreats
From gray child faces crying in the streets.

Sylvia Plath

Simply placed in the back of the The Collected Poems with other "juvenilia," and like so many of her early works an exercise in form, I fear that many people wouldn't give this a second look.

Sweater Drawer

Assuring the Doom

Is this the rope with which they will eventually hang themselves?

What is the relative value of a closed mind?

This is child abuse.

Alban Eilir; Let There Be

Admitted over a month ago for a persistent cough. The CAT scans showed a nasty empyema. Holy crap.



One of our very fine thoracic surgeons performed a VATS procedure that took care of most of the patient's lung problems, but he developed pneumonia and required prolonged intubation and antibiotics. His kidneys didn't like that and they failed, so he also required hemodialysis.

It seemed like he would need the ventilator for a while so one of the intensivist residents gave him a tracheotomy.



Then he lost it. He got crazy in the head. He'd pull out his feeding tube and urinary catheter. The medical team thought that perhaps he reacted to one of the antibiotics, which in rare instances can cause seizures. The neurology team thought he just had ICU psychosis. Whatever. They restrained him by tying his wrists to the bedframe.

After weeks of all that, they decided that he was well enough to be transferred out of the intensive care unit.

That's the punch line.

The morning I got him he looked awake and pleasant so we undid the restraints. He nodded appropriately and followed simple commands. He did his own mouth care with the swabs we gave him.

The wonderful CNA working with us got the patient up to a chair after giving him a good scrubbing and buffing. He got up easily and stayed out of bed until lunchtime, which for him was a can of Nepro down his feeding tube.

Then the respiratory therapist came along. She wanted to cap his trach with a Passy-Muir valve but even though this one could do the work of two, she didn't have time to stick around to see if he would tolerate it. We could all use a few more respiratory therapists.



We told her we'd stay with him to see how he would do. She deflated the tracheostomy cuff. As she was leaving I put the valve, sometimes called a "speaking valve," on the opening of his trach cannula. Then I asked him to say a word. Any word. You always have the patient say something before you turn your back on them, just in case they stop breathing.

"Thanks!" he said, then came his toothy grin. His voice was rough but after a while it seemed to smooth out. Quite a bit.

He asked for the phone so he could call his family. It was the first time in weeks he could utter spoken words. There was no stopping him.

After a couple hours he got tired so we took the PMV off, but I left the trach cuff deflated and showed him how to cover the end of his cannula with his finger, which allowed him to speak on exhalation.

"I almost died," he said. He indeed had been very sick. Still was, but I wasn't going to dig a hole for him. And I said so.

"I saved you all that work of digging one," he said. For that I thanked him!

His family members came to visit and he was still chatting with them when I left for home. It was a good day. It was Easter.

Sunday Plath: More Bees

The Arrival of the Bee Box

I ordered this, clean wood box
Square as a chair and almost too heavy to lift.
I would say it was the coffin of a midget
Or a square baby
Were there not such a din in it.

The box is locked, it is dangerous.
I have to live with it overnight
And I can't keep away from it.
There are no windows, so I can't see what is in there.
There is only a little grid, no exit.

I put my eye to the grid.
It is dark, dark,
With the swarmy feeling of African hands
Minute and shrunk for export,
Black on black, angrily clambering.

How can I let them out?
It is the noise that appalls me most of all,
The unintelligible syllables.
It is like a Roman mob,
Small, taken one by one, but my god, together!

I lay my ear to furious Latin.
I am not a Caesar.
I have simply ordered a box of maniacs.
They can be sent back.
They can die, I need feed them nothing, I am the owner.

I wonder how hungry they are.
I wonder if they would forget me
If I just undid the locks and stood back and turned into a tree.
There is the laburnum, its blond colonnades,
And the petticoats of the cherry.

They might ignore me immediately
In my moon suit and funeral veil.
I am no source of honey
So why should they turn on me?
Tomorrow I will be sweet God, I will set them free.

The box is only temporary.

Sylvia Plath

Plath wrote the five late bee poems over the span of a few days in October of 1962. Ted had moved out of their Devon cottage. But her writing was ascendent.

Her father was an expert on bees and had written an important textbook on them, and while living in the country Plath had tried her own hand at keeping beehives. They meant something to her...

The bees are words.

Our Present Justification

A liar tells you “go there.” So you drive in the wrong direction down a dangerous one-way street.

Other cars swerve this way and that, your own passengers are tossed and tumulted, but you persist. You do not turn off the route because you have to finish the job you started.

Many people die traumatic deaths.

Grouting

16th and Missouri

Several hundred people, signs and signs, cars honking, bagpipes and drums...

A woman driving a KTAR vehicle was oblivious to the Air America bumper sticker that someone tagged to the back end of her company SUV.

The local news crews left at 5:50 p.m. so they could make it back to the studios for air-time.

Very few obscene gestures from passing cars. Even people going by in gas-hogs were flashing peace signs and blowing their horns.

Mystery Diagnosis

He was thirty-five years old and he had the liver enzyme levels of someone who had been drinking hard, and daily, for decades. Which is exactly how they got that way, actually.

After spending a few days tweaking and boozing it up in a bug-infested Van Buren motel flop with a few of his friends, he decided to go visit his son. He didn't see his son very often. Mostly because of the restraining order. But sometimes he was just too busy.

The visit didn't go well. He argued with his ex-wife. They made up. Clothes came off. True love is like that. They fought again, and before he could get dressed she had taken their son out to the car and she was going to drive away.

He chased after her, naked. She started the car and began to move. He was in front of it and jumped up onto the hood of the Civic hatchback. She kept on driving. Neighbors looked on.

Halfway down the block lived one of Sheriff Joe's Finest. That is where she stopped the car, right in front of the deputy's house, hollering at him to get off.

This had been going on for a bit and someone had called the law. As he walked back to get his clothes police and an ambulance arrived.

And that is how he came to be admitted to our hospital to be treated for chest pain.

Snow Sunday: Plath in November 1962

The Night Dances


A smile fell in the grass.
Irretrievable!

And how will your night dances
Lose themselves. In mathematics?

Such pure leaps and spirals -
Surely they travel

The world forever, I shall not entirely
Sit emptied of beauties, the gift

Of your small breath, the drenched grass
Smell of your sleeps, lilies, lilies.

Their flesh bears no relation.
Cold folds of ego, the calla,

And the tiger, embellishing itself -
Spots, and a spread of hot petals.

The comets
Have such a space to cross,

Such coldness, forgetfulness.
So your gestures flake off -

Warm and human, then their pink light
Bleeding and peeling

Through the black amnesias of heaven.
Why am I given

These lamps, these planets
Falling like blessings, like flakes

Six sided, white
On my eyes, my lips, my hair

Touching and melting.
Nowhere.

Sylvia Plath
6 November 1962

With her marriage on the rocks, Plath decided to leave the cottage in Devon. She spent much of the month hunting for a place in London. To help her secure the apartment on Fitzroy Road, Ted posed as her still-present husband and together they put down over a year's worth of rent.



The flat, once occupied by Yeats also, is the one with the litle blue plaque. Ted visited often enough and took the children out to the nearby zoo.

Plath's journals fizzle out months before. Apparently she spent much of November moving. That was a notoriously cold winter in London, and I imagine she once found herself standing outside watching snowflakes twirling in the night, falling on her, melting.

Lamp Stand

What Hillary is Doing

I will tell you.

She's fighting to win.



Hitting below the belt? Playing the race card? Alienating her base? Spoiling all the advances ever made in the entire history of feminism? Employing Rovian smear tactics? Destroying the American family? Embarrassing her momma?

Who cares.

I actually heard an Air America liberal talk-show host who has a national following tell her listeners to write in "Obama" rather than vote for Hillary if she is the one on the Democratic ticket come November.

Wouldn't that just be giving the election to McSame?

Hillary and Obama are not friends. They are politicians. If politics requires them to come together, then they will, even after shivving one another in the primaries. The important thing is that neoconservatism is a gross failure and a Democratic president must take the helm in January 2009. Is that really so difficult to understand?

Late Sunday Plath

The Moon and the Yew Tree

This is the light of the mind, cold and planetary
The trees of the mind are black. The light is blue.
The grasses unload their griefs on my feet as if I were God
Prickling my ankles and murmuring of their humility
Fumy, spiritous mists inhabit this place.
Separated from my house by a row of headstones.
I simply cannot see where there is to get to.

The moon is no door. It is a face in its own right,
White as a knuckle and terribly upset.
It drags the sea after it like a dark crime; it is quiet
With the O-gape of complete despair. I live here.
Twice on Sunday, the bells startle the sky --
Eight great tongues affirming the Resurrection
At the end, they soberly bong out their names.

The yew tree points up, it has a Gothic shape.
The eyes lift after it and find the moon.
The moon is my mother. She is not sweet like Mary.
Her blue garments unloose small bats and owls.
How I would like to believe in tenderness -
The face of the effigy, gentled by candles,
Bending, on me in particular, its mild eyes.

I have fallen a long way. Clouds are flowering
Blue and mystical over the face of the stars
Inside the church, the saints will all be blue,
Floating on their delicate feet over the cold pews,
Their hands and faces stiff with holiness.
The moon sees nothing of this. She is bald and wild.
And the message of the yew tree is blackness - blackness and silence.

Sylvia Plath
22 October 1961



That's the yew tree in the poem. Plath could see it from her window. In his note for this in "The Collected Poems" Ted hughes indicates that Plath wrote this ay his suggestion as "an exercise."


It hardly seems that way to me. The switch had been thrown. It's been said that Hughes himself was greatly disappointed by the direction taken in the poem. It may just be that he was startled, or perhaps a bit shocked, by the intensity of this emergence of Plath's Ariel voice, as is clearly the case with this poem.

Soon after writing this, ironically Plath was awarded a large sum of cash to allow her to work on a novel. She'd already Finished "The Bell Jar." So it was free money. Nick would be born three months later.

Options

No wonder he was complaining of a racing heart. His urine drug screen showed cocaine and methamphetamine. He complained that we "weren't doing anything for him" and he wanted to leave so he could go smoke a cigarette. So good for the ailing heart, that.

He was on a Cardizem drip for awhile and his rate did stabilize. The docs changed it to oral Cardizem, but his heart sped up again. The case manager suggested that we get another urine specimen, and it showed methamphetamine. Either his friends had brought him more or it was simply still in his system. It can take two to four days for meth to drop from a tox screen. The cocaine was gone though, so my guess it that he did crystal... while in the hospital for rapid atrial fibrillation.

That's how smart a guy he is.

"You don't even know why my heart does this," he'd say, challenging us to fix him, and I'd tell him that lifestyle seemed to have something to do with it.

There's no effective medical treatment for a bad life.

Some people just give up. I never do.

Sheer Curtains

Another Reason To Go There

Interesting political news from Vermont, a state sometimes referred to as the "democratic socialist republic of..."

"MARLBORO, Vt. (AP) - The focus was in Brattleboro, but when it came time for Town Meeting, another town beat Brattleboro to the punch in calling for the indictment of President Bush and Vice President Cheney.

In a non-binding floor vote, residents of the southern Vermont town of 978 people approved an article that calls for Bush and Cheney to be arrested for crimes against the Constitution."

Unless they get impeached first.



Get it? He's standing on a table. With a sign that says the "i" word.

Bush himself has never visited Vermont. As for Cheney, I don't know if he has or not, but I am reasonably sure he's never shot anyone in the face there.

Sunday Plath: Another Baby Poem

Morning Song

Love set you going like a fat gold watch.
The midwife slapped your footsoles, and your bald cry
Took its place among the elements.

Our voices echo, magnifying your arrival. New statue.
In a drafty museum, your nakedness
Shadows our safety. We stand round blankly as walls.

I'm no more your mother
Than the cloud that distils a mirror to reflect its own slow
Effacement at the wind's hand.

All night your moth-breath
Flickers among the flat pink roses. I wake to listen:
A far sea moves in my ear.

One cry, and I stumble from bed, cow-heavy and floral
In my Victorian nightgown.
Your mouth opens clean as a cat's. The window square

Whitens and swallows its dull stars. And now you try
Your handful of notes;
The clear vowels rise like balloons.

Sylvia Plath

In her Collected Poems, this one carries the date of 19 February 1961. Her daughter Frieda was born the preceeding year on April 1st so she would have been ten months old at the time this poem was finished.

It is indeed a "song" and its lyrical qualities shine through. That central image of "a cloud that distils a mirror to reflect its own slow effacement" is just so perfect.

The final lines melodically stick a while, too: the baby's cooing and babbling a "handful of notes; The clear vowels rise like balloons." As a parent I know those wonderful sounds, though it has been some time since I last had the pleasure of hearing them.