It does not matter whether you are a theist or atheist, what matters is sincerity, forgiveness, and compassion.

– His Holiness the Dalai Lama

I think this is the most sensible thing I’ve heard from a member of the
Catholic clergy in a long time:

The Roman Catholic Archbishop of Cardiff Peter Smith told the BBC: “We must not kill an innocent person under any circumstances, there is no moral justification for that.
“But when it comes to the end of life, we wouldn’t take a vitalist view, and
say somebody has got to be kept alive by most extraordinary means.”
(http://news.bbc.co.uk/2/hi/uk_news/7956845.stm)

Regarding a baby with serious medical issues that was taken off life support
despite the parents wishes.

It’s an interesting and difficult ethical issue, I think.

Also, I see a lot of Catholic patients who have “the full monty” when a less is
more approach would be, in my mind, more ethical and cause less suffering for
everyone with regard to end of life care.

My suspicion is that many of these patients justify their decisions by
expressing what they’ve heard or think they’ve heard from clergy in an attempt
to avoid the heart of the matter – which is that they are afraid to die.

I wish that more Catholic clergy would be more outspoken about reasonable end
of life care.

It would also be great if everyone would read about how Socrates handled his
end of life and his argument that fear was pretty unreasonable.

Quoted from here.

He says that emotions follow from knowledge, and since he has no knowledge of what death is, he has no feelings or emotions about death. Socrates only has emotions if they are first authorized by reason, so it is illogical for him to be afraid of death when he knows nothing about it. “To fear death, gentleman, is no other than to think oneself wise when one is not, to think one knows what one does not know”

The actual “Apology” can be found here.

I wasn’t going to post and, in fact, have resisted posting even though my little sister has been nagging me to put something up. So, this one’s for you, Laura. =)

It’s an interesting thing, watching someone die. As a new nurse, I’ve had the opportunity to stand by at least half-a-dozen people as they took their last breath and left my shift knowing that others wouldn’t be alive when I returned to work the following day. I don’t think nursing school does, or can, prepare one to handle the dying. We talk about healing, caring and comforting but there is something very strange, surreal, sacred and odd about being in a room with a person who is about to die or has just died.

I’m not sure why we don’t talk about it very much. Sometimes I wonder if it’s just our aversion to admitting that we are all dying, if it’s our unspoken fear of our own death. I wonder if it’s just that we like to think of death as very spiritual when in fact it is very uncomfortably physical. Death can be awkward, painful, unpleasant, gross even. Does it sound immature to say that death can be gross or disgusting? It can be, I think.

Recently I had a patient on a ventilator (a breathing machine) that died. She was DNR, so there was no intervention for her, we just waited as she died, tending her as best we could – changing her position so she didn’t develop pressure sores, cleaning her mouth and speaking with her while we cared for her. The odd thing about this poor woman was that the machine was breathing for her, so it was difficult to tell if she was really dead. The telemetry, which monitors her heart rate, was signaling a wide variety of pulses (from 30 to 120 beats of her heart a minute) something she had been doing for hours so when her heart went into pulseless electrical activity (PEA) we were unable to tell she had no pulse without checking her pulse at her radial (wrist) or other location.

If you’ve never been on a hospital unit working, then maybe you’ve been a patient and wondered what all the nurses are doing when they aren’t in your room. Well, we’re generally in other people’s rooms or doing tons of paper and computer work. So occasionally we would glance at the telemetry machine and note that her pulse was varying widely, that her oxygen saturation (the amount of oxygen in her blood) was good and of course, because of the breathing machine she was still breathing. As a new nurse I wasn’t really sharp enough to put everything together – but I assumed that her oxygen saturation would drop noticeably when her heart failed to push the blood through her lungs and this would be my indication of her death.

Well, it wasn’t so. Eventually I went into the room to check up on her and noticed she was the color of wax, a dead person’s color. She was breathing because of the machine but she was cold (and had been cold and mottled for most of the day as death approached) but I couldn’t get a radial pulse. I then checked her pulse at her carotid (her neck) and couldn’t find one there. It dawned me then that her heart was either quivering ineffectively or the breathing machine that was making her lungs work was stimulating her chest just enough to convince the heart monitor that her heart was still working.

It takes two RNs to confirm death so I checked a few other ways – corneal reflex, noxious stimuli, and blood pressure. None of which was successful. Oh, and I listened to her apical pulse (using a stethoscope to listen to her chest for a heart beat). Everything was negative. Since the respiratory people were present, I had them remove her from the breathing machine to determine if she would breath on her own. She did not.

The next thing I had to do was get another RN to verify my patient’s death so I could call the doctor and inform him and get clearance to call the family and send her downstairs to the morgue. I was surprised to see how unfamiliar my peers where with handling death. I don’t know if age is a factor – at 41 I’m a pretty old “new nurse” and many of my peers on the night shift are in their early to mid-twenties. I eventually had my charge nurse, a woman with many years under her belt confirm death with me, but it was odd to watch how these younger nurses, people in general and myself handle the dying and recently dead.

There is an odd fascination with the person lying there. They are vulnerable but you have to do things with them – things like bagging them up – wrapping them in the “death shroud. ” You have to clean them up and remove their lines and tubes (if they are not going for an autopsy). I don’t know if you’ve handled a dead person, but it is a singular experience, to say the least.

Some people get giggly, which annoys me, others get callous and others, like me, turn inward and get very quiet and “reverent” I guess. I don’t mean to make it sound holy, because it isn’t, but I think all three strategies are doing the same thing – helping us cope with the fact that there is a corpse in the room that used to be a person and we have to interact with that corpse.

Think about it. How exactly do you go about doing something like that? Especially a corpse that may not look very good (if the person was very sick) or leaking various fluids from various places, how would you handle this? We all have our ways and none of us learned them from school. It is an odd thing.

It is an odd thing to be a nurse and be exposed to this in a far more intimate way that most people.

I do appreciate the opportunity to take care of a recently dead person, especially if it’s one of the patients that I know fairly well or is one of “my” patients. I feel like it’s my opportunity to tie up loose ends and make sure the care is the best I can give up to the very last thing. I prefer to take them to the morgue myself, but often I cannot do this as I have other patients to tend to. I find this unfortunate.

There is also this aspect of being in a very odd place at a very odd time for me when I’m in a recently dead person’s room. I like being in there and tiding up before the rest of the crew arrives to help me manage the corpse. I like getting rid of supplies, straightening up the room and organizing things. I like it because I feel odd being there and I want to prove to myself that it’s ok to be there and give this care even though I would really rather be anywhere else. It is where I’m needed right then.

Actually, this reminds me of something else I experienced just last night. I had a patient (not dying yet – any more than the rest of us) who was, for me, a very difficult patient. I found that I did not like him. He was annoying to me, he was smelly, he was unmotivated and he was needy and had medical problems for which I could do nothing while I had plenty of other patients for whom I could actually do things for.

I am aware that wanting to help patients for whom I can feel effective and avoiding those that don’t’ allow me to feel effective is completely ego-based. Both types of patients need care and both want, generally, their nurse at their bedside the entire night. This guy, however, was just irritating me left and right.

So, at some point last night, after reading his extensive medical history, I went into his room and sat down on his bed (he was sitting in the chair) and let him talk to me about his depression, his hopelessness, his bizarre anxieties and his mistaken ideas until I could let go of myself and let myself develop an empathy for him. It reminds me, now, of how I feel when I’m in the room with a recently dead person. I don’t really want to be there, but I want to step outside myself and be present for that patient, even if they are dead or even if I don’t particularly like them.

I mentioned this to someone last night when they asked me why I was hanging out in “that guy’s room for the past hour” (no one else like the dude either) and I said “because I didn’t like him, I wanted to sit with him.” They said “You’re so nice!” They lauded me with a few other undeserved complements also.

Those who don’t know me very well might assume I’m preaching here or displaying how kind I am. This is not what I’m trying to do. What I’m trying to explain is that I am aware of my bias and ego-based perspective and trying, very hard, to get around that and experience the awaked heart of Bodhicitta. It was not me being nice at all. It was me recognizing my small-mindedness and having just enough mindfulness to look at it for what it was. I suppose that is what practice is all about.

I can’t say that I liked him after that, but I was able to have a far more “middle of the road” attitude about him. I’m glad for that.

This recalls, for me, a meditation that Robert Thurman performed in his book (I have the audio version) The Jewel Tree of Tibet in which he talks about visualizing three groups of people standing in front of you – to the left people you definitely don’t like, perhaps even hate (I don’t’ think he used that word), people in the middle whom you don’t care much for or against and people on the right for whom you have utter love and caring for. He then goes on to suggest we notice that some people that were in the middle at one point are now in one of the other groups, perhaps we love that person now or really dislike that person. The same is true for those we loved or disliked. We can then, through this meditation, realize that our feelings for people are quiet arbitrary and based not in qualities of the persons themselves, but rather based on our moment-by-moment perceptions of these people. Realizing this, I suppose we can learn to let go of our biased perceptions and treat all people with equal compassion and caring.

Well, there’s my blog post. Hope you’re happy, Laura. =)

Time to go…
they say the journey is a long one:
change of robes

- Roshu, 1899
Japanese Death Poems

Lately I’ve been thinking (and have posted about it – if you’re that darn curious you can go try to find the posts yourself) that blogging in the manner I have is starting lose its luster.

I’m not sure anyone needs another person to rant on about their thoughts and feelings randomly throughout the day. When I think about it – the reading I do online is exactly not that.

One of my sisters got me to thinking about why I blog and what I’m looking for. It helped me see why this certain type of blogging has lost its luster (partly, anyway).

I like discussion because it helps me clarify my thinking on things. I don’t learn much by talking though, except perhaps when I catch myself in error. I prefer to hear the arguments put out there by others and I enjoy considering them and mixing them around with my own ideas.

Blogging started, for me, at a time when my closest friends were not available for spirited discussions and I didn’t have an outlet for the crazy, mixed-up ideas I was having. Blogging at least provided me with half of what I was looking for – a place to say what was on my mind and occasionally, if I was lucky, someone who disagreed with me.

I am now, however, in a position where I have my ‘hands in the dirt’ of philosophical questions – I’m working as a nurse and nearly every day I’m confronted with ethical challenges and my fiancee, despite her best attempts, tends toward the philosophical as well. Or at least she disagrees with me frequently which gives me a lot to think about.

So, as you can see, my need to randomly spew my thoughts on the ‘net is greatly lessened.

Another change that I’ve noticed is my weariness with discussing unanswerable questions – at least hypotheticals dealing with god, good and evil, the afterlife, all those kinds of things. I don’t know if its age, that I finally realized the horse is already dead or what, but I just don’t care enough anymore to get worked up about the questions.

Am I more interested in writing experientially? I suppose (witness my previous post) but even here, I’m not sure that the world needs yet another blog about these types of things.

Well, I’ve decided to open a website that I had a long time ago – KillerGoldFish.Com and develop it into a site that’s useful to me. I’ll host some photos there, I’ll post bits of things that I find important to me so that I can reread them or share them with my friends and cut back on the personal commentary.

I’ll keep this blog alive for awhile, I suppose, we’ll see what happens. But really, I’m interested in writing about the books I am reading, my experiences with Zen Buddhism and with nursing.

I’m not sure those topics are all that important, but I know my half-arsed ramblings are definitely not. =)

So, I suspected it would happen, but it was took a long time in coming!

I’ve been regularly running since July – just after I took my RN boards. It’s been really nice to have the time to get back into shape and running is something that I’ve always enjoyed. However, owing to a bout of plantar fasciitis, I took my running indoors and have been using a treadmill. Treadmills are far more forgiving on the feet than asphalt and I figure this will help protect me from another injury, as will a sensible stretching routine and good orthotics.

I, personally, have always hated treadmills. I much prefer running outdoors and without headphones. Back in the days of runners wearing 3″ inseam shorts I used to take personal pride in chasing someone down if they were wearing headphones. For me, I liked to stay focused, intense and, to be honest, be distracted by the changing scenery of running out doors.

In college I had a friend, Nervous Rex we used to call him, who could easily put ten miles on a treadmill. I don’t know how he did it but I was secretly envious that he could somehow tune out and just run or that he had so much willpower. I didn’t, and probably still don’t, understand what it took to run in place for ten miles but certainly I was curious what was in store for me as I embarked upon my treadmill training.

At first, being old and fat, the running wasn’t that bad – half a mile, a mile – that’s only a few minutes. Hit the bike after and I was done. As my mileage progressed, (bear in mind I’m running three miles on the treadmill currently and immediately riding a half-hour on the bike – heart rate around 140-170 the entire time, usually spending about 50 minutes on my workout, for those interested) I found I really had to play head games to break the mile and a half barrier. I was getting bored, focusing on my effort and really just hating my run.

Then I started reading a few ultra running blogs (races of 50-100 miles in length, hey, a man can dream, right?) and this one dude wrote about using his iPod set to trance music to slow his running down so he could just keep churning out the miles for hours (something like 24 hours at a pop, for him). So I plugged in my iPod and kept at it. I still was playing massive head games – not letting myself look down at the mileage indicator on the treadmill, counting out songs to before I was allowed to guess how far I had run. It was, I admit, a little mentally exhausting.

At some point I started just trying to stare ahead at my reflection (the machines I run on face a mirror, stair-steppers behind me) and watch the Rorscharch Sweat Blots on my chest slowly grow. I couldn’t look down at the mileage until it was quarter-sized. I started making patterns out of the shapes – is that a old Zen monk carrying a staff looking down at a cat (random Zen Cat link) ? Now is it something else?

It seemed to work. I’m running three miles now and it seems pretty easy. I’m probably due to hit three and a half this week. Anyway, awhile ago I figured all this staring, listening to trance and repetitive motion would likely lead to some trippy experiences. It hadn’t until today. I don’t know. Maybe up till now I was too deep into the pain.

But, today Insite, a song by MIDIval PunditZ started playing and everything in my head kinda changed. Suddenly my steps were completely in sync with the music, I felt like I was dancing, even the swaying of the cords connecting me to the iPod and the treadmill bounced along in time to the music. The folks stepping behind me suddenly looked like background dancers. I had to stop myself from laughing. The feeling was so surreal. I was dancing – felt like I was sliding forward and not really running at all. My shoulders felt like they were shaking side-to-side as if I were dancing rather than running. The impression was so odd and so compelling. Suddenly it was, for a few minutes anyway, like I wasn’t running at but just jamming to this amazing tune; very odd and amusing.

So, while I’m running, a short while after this entertaining moment, I start getting all saddled up on my philosophical horse (it’s high, I need a step-ladder) and start thinking how this running in place I’m doing is just like living life. I’m not going anywhere. It ends the same, I’m going to hop off the treadmill and it’s going to be over, nothing much is really going to be accomplished. Just like life. You get born, you do some stuff, you die. Not much is different, really.

But it seems to me, also, that this perspective is missing the important part. The important part while running on this treadmill is what’s going on inside my head. The experiences I’m having, the way I’m interpreting and trying to understand the world around me. The change is centered in me, the only place it really can be.

This too, seems like real life, at least to me just now. Life is short, difficult, often painful and the only thing I can take with me to my deathbed (with any luck) is what’s rolling around in the hat holder perched on my shoulders.

In any case, it was a great song by a great band. Gonna hit the gym tomorrow too.

Here’s an interesting article (Washington Post) that discuss, pretty convincingly, I think, why Obama is not black.  I found it pretty convincing.  Maybe we didn’t elect the first black president after all, we elected the first biracial president.

I just hope we can one day get rid of terms like “black” and “white” and “racial” when we mean “ethnicity.”

But that’s just me and my pet peeves.

=)

This election does matter.  In matters of ethnicity, it matters a lot.  I wasn’t clear about what I was criticizing in my last post and Ed (and probably Ghetto, also) called me on it.

It means a lot that a black man who didn’t run on the “black man race card” won.  It says a lot about what American can be and how far we have come.  Obama, himself, will do, has already done, great things for our international reputation.

One only has to watch Colin Powell’s discussion of Obama’s election to see how powerful this has been to black America.

In my previous post I did not mean to demean the importance of Obama’s election.

What I meant to say was that the political machine that is America will not change very much.  If at all.  The rich rule the poor – this is the way it always has been.

I hope that Obama can inspire and motivate people in the direction of peace and diplomacy.  I hope that he can turn America into the light of hope and freedom and democracy that it could be – but I suspect that life will go on as it has.

Still.  I do nurture a small, quiet hope.  He’s no savior, but he’s young, vigorous and intelligent.  That’s something we haven’t had in eight years.  It’s a good change.

I wanted to post tonight, before the results of our elections are completed so that it would be clear that I am not affected by the results of the vote.
Obama may win tonight; he won my state, Vermont. McCain may win tonight, he’s won Kentucky. But this doesn’t matter too much. Let me tell you why.

I was chatting with an LNA on ICU today when I had a break from patient care. She told me a story that really articulated what I feel about the political process in America and a big reason why I vote Green despite being accused of “throwing away my vote” every four years. Note: Vermont didn’t have any greens on the ballot this year – looks like I have some work to do.

This LNA told me about a time she and a bunch of nurses took a passel of handicapped kids down to the Capitol Building to take part in a lobby exercise for increased awareness of organ donation. She told me how all sorts of folks in their “800 dollar suits going to their 400 dollar lunches” were budging and pushing in front of kids in wheelchairs to get on elevators and never paid any mind to the children. For her, right then, it became apparent that the Democrats and the Republicans were both really the same party. I agreed. We both believe that the power-makers in Washington, Red and Blue are both really from the “I don’t give a crap, I got more money than you” party. And, unfortunately, I’ve never seen anything to prove otherwise.

I vote Green because I believe in their platform. There will probably never been a Green President but then, that’s because they aren’t in the same party as Obama and McCain. It’s probably better that way, anyway. At least I know there are like-minded folks out there.

In the end, it won’t matter very much. This financial crisis we are in, this war we are in – they both happened while both parties were on watch. And it will happen again. Even if some bizarre thing happened and Putin was elected Czar of America – it wouldn’t matter. Some new things would suck, but some other things wouldn’t suck. In the end, we will be a mix of feelings about our government.

My fiancé and I were talking in the car tonight on the way to the polling place. Though we both feel very strongly about the visible candidates we both admit that it doesn’t much matter. There will always be sick people to take care of – whether there is money for it or not – and that’s really the most important thing, isn’t it, taking care of each other?

Edit to Add:

Maybe the elections DO matter – I got my first “hate” comment from a guy I thought was a pretty cool and open-minded sort.  I would accuse him of being a liberal commie – but I’m as liberal as they get, generally speaking.

Anyway, to address his point, electing Obama does matter in some ways – but I was referring to the political positioning in America and the fact that we are really a aristocracy more than a democracy.  Get off your high horse, Ed.

M