he got his last prayer. he got his last meal.

I think justice was served...
It's closure for a lot of people...
I think it was a very generous death for him...


Saddam Hussein is dead. He was hanged yesterday by verdict of an Iraq court. Folks here in the US have many comments about what this means to them, what they think it means to the world.

Justice. An eye for an eye. Punishment for torture and cruelty. Is it that simple? This makes me think of 911 - even though they are not related the way the media brainwashed us into thinking. I mean that a group of men hijacked some planes and crashed them into two tall buildings killing 3000 + people and our reaction was - who did, go kill them. What was our part in it? Why would someone want to fly two planes into the buildings in the first place? How did Saddam get in power? Someone must have liked him. Hell, 51% of America liked Bush, for awhile. I guess I just hate the knee jerk reactions that happen. I'm not sad Hussein is dead, I'm sad he ever lived the way he did. I'm sad for all the Afghani people we killed in hunting Bin Laden, if he was even the master mind as the spin told us. I am sad for the 51% of America who thought Bush would take care of us, lead us, give a shit about anyone except his friends and pocket. I'm sad that someone thinks hanging is generous.

Death is what it is and it will happen to us all. For all the folks who don't get their last prayer, last meal, what does this mean for them in their death. I know what it means for those of us left behind to sort it out, each in our own way. It is true, Hussein can no longer torture people, rule badly, cause any more harm... at least not directly; and that is good. What we do with his memory is another story.

Whatever he did, whatever he stood for - let those of us left behind be anything but that, and put something healing out there for the world. It's all we can do, ja?

the balancing act

Context is key. This might be an excuse or it might just be that 'it is what it is'. I'll let you be the judge. Because that is what people do; hell I do it myself to myself and this post comes from that place. Last night I found myself laughing like mad with my co-worker, wingnut, about a few of our patients. Already that sounds awful - but it's true and I refuse to regret it. I will likely always twist this one around in my brain. It's like watching someone slip and fall on ice, or get their tongue stuck to an ice cold pole - that shit can be incredible funny at someones expense. There is humor in a great many things and we of the medical underworld laugh at people's illness. We laugh at vomit, at diarrhea, at jaundice, at screaming and gorked out patients. It is appalling the things we find funny and what does that say about our compassion? I think you can take it on a person by person case - because surely there are some callous assholes among us - but they tend to stand out by being genuinely annoyed by the patients - the people they dedicated their lives to caring for. Oh the irony in THAT one. I digress.

So who does my humor hurt? Well, I can tell you it makes my co-workers laugh until their sides hurt and I'm cool with that. Laughter is the best medicine and really, we need something to balance out the pain and suffering we see, we care for, we make decisions about how to lessen, lighten. I love what I do. I listen to my patients. It is the connection to these folks and the lessons they repeatedly teach me that I respect. I fight for them, for their care, for the nurses to give them respect, for their doctors to tell them what they need to know, for their family members to understand their situation, for the fucking bloodsucking insurance companies to cover them fer fucks sake. I'm no saint, and not even that unique really,after all, it's not about me - it's about them.

And they make me laugh and that little gift keeps me open, makes it possible for me to sit in their suffering and illness and frustration and give them whatever I can. I understand the rules of politeness, of respect for not saying stupid shit that taken out of this context can be very, very offensive. I try and never say anything I'm not willing to have anyone overhear and I'll stand by my words. Say what you mean and mean what you say, says I.

Wanna hear a funny story?

letting go

Responsive only to pain, she barely opened her eyes when i ran my knuckles on her sternum. Anyone else would have punched my lights out; if only she could. But she's way past that now. Her blood pressure is dropping, her white cell count is climbing, fever is only a matter of time. The antibiotics aren't touching whatever is causing the infection. Her kidneys are shut down and we haven't been able to drain the toxic waste from her abdomen because it might drop her blood pressure in the toilet and cause a heart attack. Her tube feed backed up to the top of the tube this morning and we suctioned tube feed from here lungs. Sepsis, the nemesis of healing, the hospital ward welcoming committee if you stay long enough.

She's been here for 22 days; it started when she passed out at home. She's only 63, and she's trying like mad to leave us. Is she even in there? I wonder when I go in to draw blood cultures to see what's growing in her bloodstream, making her sicker. The stream of doctors and consults have come like a river of advice that the family watched flow by, unabided. Her prognosis is so poor, and everyone has laid it out for the husband, the children. The merciful thing would be to sign a DNR/DNI (do not resuscitate, do not intubate), give her pain medication and let her rest. She lays there with her mouth slightly gaping, lines and tubes sticking out everywhere. Where is the love in this, keeping her plugged in and turned off - who is this about?

The last sentence in the note from the attending reads: "....have explained prognosis in detail to family, answered all questions requested DNR/DNI for patient. Family members fully expect a miracle. Full code."

Why?

defervescence

He was walking toward her, bare-chested, a Japanese black wrap covering his lower body only slightly darker than he; the hilt of the sword gleaming in the sun, swinging alongside as he strode toward her. His face looked peaceful and she began to think this was a merciful end as he gracefully drew the sword, towering over her. "You need to sleep, but first you need this" she heard him say, knowing only a friend, as old as he was to her, would she let get this close. She was sure she heard the long steel blade sliding out of the sheath, almost like the sound of water over rocks. The vision of him blurred as he approached her and she could feel her head being lifted. Soon it would be over and she couldn't find regret it in her anywhere, she let her eyes close. Swallowing hard, she thought there were pebbles in her throat. She tried to swallow once more then tried to speak, but the river was flowing and she decided drowning was just as good. She seemed to cool from the inside out with each breath, the water in. Her head felt light and she began to hum. She heard his laughter as if in another life and then she was floating, her legs and arms bobbing like paper things, soon wafting down into a heap.

Standing atop a mountain the sun shone brightly on her, the swaths of farmland on the near vertical slopes created a patchwork, as if a giant quilt had been draped over each peak. Looking around she could see the small town below here and the Amazon River winding off to the South. A small dark-skinned barefoot boy in brightly colored clothes walked up to her and smiled. She smiled back and tried to speak, but could not find her voice.
"Tienes sed?" he asked in a small and steady voice. She nodded yes and he disappeared like a breath into a stone doorframe, the scent of sweet plantains as if air, and reappeared moments later with a small cup of dark liquid. She bowed toward him taking the cup and let her eyes close as she did this, falling into the liquid.

She felt warm, all over, and only when the breeze began to make her dry again did she open them to find herself looking down a soft wooded path at a person in a distance, a woman.

She was still so thirsty and found it hard to swallow. Maybe the woman would have some water to share. Hum staggered forward and when the breeze blew again she felt an ice cold chill. Her clothes were soaked through and she began to tremble trying to warm herself. The light was taking its leave and she tried to call out to the woman to slow down; she would never be able to catch up. A small cough escaped her tired throat and the woman stopped, but didn't turn. Hum's vision began to swim and her lids dropped like small stones.

The scent of sweat and something familiar made her lift her head and she felt an arm around her waist, helping her walk. "C'mon babe, just a little farther" was the voice soft, warm and familiar. Hum began to weep from a place deep inside. She was not alone, the woman who once showed her all the possibility in the world held her securely now, sitting her down on a nurse log. Hum felt a deep sense of longing rise up in her, making her weak, and without turning her head at all, she knew it was Daria.

"Why did you go?" she heard her own voice croak, barely a whisper.
"You didn't need me anymore, you know that" Daria said matter-of-factly as she wiped the sweat from Hum's brow and set her pack behind Hum to prop her comfortably so she could pull some water.
"I wasn't done, we weren't done; you showed me so much and..." Hum trailed off, knowing this was the weak part of her, off-center and small.
"You are so much stronger now and that strength came in the wake of my departure. You know that. You wanted, and I wanted, but our paths diverged and you didn't want to accept that. I understand. Hell, I didn't want to leave you either, but it was written in the wind. I still love you, but I don't need to tell you that." she said sweetly as she held the water to Hums dry cracked lips. Hum knew it was true, but the ache inside her from the excision of that connection was like a wound that never quite healed. She wanted to protest, but deep down she knew it was futile, false and instead she reached out and placed her hand on Daria's chest, resting gently over her beating heart.
"Is that why you're still out here? Are you trying to find him?" she asked. Daria smiled and kissed her gently on her forehead, like a splash of water to a fire.
"I know where he is. I'm trying to find my own way now. Have you found the beautiful princess yet?" she smiled radiantly. The question was serious but still silly sounding from such a strong, bold woman.
"She doesn't exist. I've stopped looking" Hum stated quite plainly.
"Good, you'll put out your own light looking and then how will she know it's you?" Daria retorted. Hum laughed, a deep sound vibrating through her ribs, it hurt her chest and her throat, but she laughed all the same. "I miss that laugh" Daria said wistfully as it filled her. Hum wanted to say that she didn't need to, but she knew better and their time was short now. Hum took her face in both hands and uttered 'a mountain keeps an echo deep inside itself, that's how i hold your voice'. She said it with a certainty Daria has never heard in her voice before. She kissed Daria lightly on the lips and as she pulled back Daria whispered "I knew you would find yourself. I saw it in you. And she's out there, closer than you know".
"Maybe" Hum whispered back and then let go of Daria and turned away. The sky went black and the rain began to fall. Hum walked for what felt like a very long time. The wooded path became an open field which fell to concrete. The buildings sprouted up around her and the noise filtered in slowly; a garbage truck, a fire engine siren, people talking loudly over the din. She was shivering and her head began to ache when she realized she was lost. How could she be lost? This was her home, wasn't it? As she shuffled down a street looking for a subway, she felt the hair on the back of her neck rise up. She stopped and looked around. Everything felt familiar, but still she knew she hadn't been here before... not yet. The wind kicked up and the chill ripped through her.

"Hum. Hum girl. Shit" he mumbled to himself watching her shiver in her bed.
"How's she doing?" Szu asked peering over his enormous shoulder.
"Not much better. I'm beginning to wonder if we shouldn't just take her to the..."
"no" she whispered through parched lips.
"damn girl, you were starting to scare me" he said turning back to her and smiling.
"thirsty" she mumbled, never opening her eyes. He wrapped one large arm around her as if she were a small child and not a woman at all, and sat her up. She sipped from a warm glass of water that had been by the bedside. "What time is is?" she asked.
"About 1 am. how you feelin?" he asked sitting back and relaxing a bit.
"I think I need some new pj's" she said pulling a soaked t-shirt off her chest, "but I think my fever broke" she said. He pulled out a thermometer and a minute later said "98.9, close enough”.

“Close enough” she whispered back still washed in the memory of where she’d been.

i CANNOT believe they left us alone

1:01 am
I graduated as a physician assistant 4 months ago. I was hired by a prominent private inner city hospital 7 weeks ago here in the city that never sleeps and that's exactly what I'm doing right now; not sleeping. It's my first overnight shift, 7pm to 7am and my partner in crime is 3 weeks senior to me. We are like tweedle dee and tweedle dum, except I call her wingnut and she calls me window licker -yes, out loud. Our chief PA watched over us until midnight, everyone on the unit seemed to be "in for the night" and we had finished 2 admissions each. When the chief left, I looked over at my partner in crime and said "I CANNOT believe they left us alone" and we both started laughing like madhatters.
We are currently the medical professionals in charge -effectively the "docs" on the cardiac telemetry unit. Telemetry = heart problem . All I can think is, seriously, what the hell were they thinking; 'they' being the powers that be, our bosses. I can hardly believe they deem us capable of handling any dilemma which could consist of elevated blood pressure, maybe some unexpected vomiting, or maybe a BIG FAT HEART ATTACK. Really, what would I do if one of the lovely nurses came to me and said "Mrs D is having chest pain and she feels like she's GOING TO DIE! What would you like me to do?". At that point, I might start by taking my own pulse. I mean really, we're just sitting here waiting for something to happen. It's a bit like holding your breath, except that you're not allowed to pass out. You're in charge. So here we are....waiting for 7 am.

2:11 am
I can't effin believe James Brown is dead!! What the hell am i talkin about? the last time i saw him on some awards ceremony he could barely walk to the podium, and he looked like an old leather baseball mit. But he did say some smart thing about the young people need to stop using such eff'd up language in their lyrics and we need to share the love. Right on brotha, right on. Me and wingnut are chowing down on pb & j's and carrot cake. I am currently wiggling vigorously to 'get up offa that thing'. Go on James, say it like it is. UH, Uh, OOwwwwww, Uh, yeah, get up offa that thing. The chief just called to check in on us. When I told her everything was fine, she didn't really believe me. I wonder if she'll sleep at all. We have two more admissions coming on. Poor bastards. Damn this pb&j is good. I wonder how many neurons are actually firing in my brain right now.



4:46 am
know what happens at 3 a.m? well most people are sleeping, even here in the hospital they are sleeping, but not if I ordered labs on them to be drawn at 3am. Then they come wake the patients, stab them and take blood from them. What did my chief say earlier "this is the hospital, don't expect to get rest here. you want to rest, go to the hilton." nice, right? it seems at times, like they're trying to beat the patient care attitude out of me. I told her that won't work; they tried to do it in EMS for 4 years and were unsuccessful - i still care.
Orrrrr, they don't come; even though we tell them to. We order the labs for 3am and the lab people don't answer the phone, and then when they do they tell you they don't know where the phlebotimist is and you can't page them. The phlebotomist is mysteriously walking the halls, diligently doing his or her duty, or napping somewhere, or who knows. But the labs don't get drawn. It's making wingnut very unhappy. she's actually trying to track the phlebotomist right now. Poor bastard.

I have a patient, a frequent flyer, come up from the ER where they did emergency dialysis on her because she had SOB (that's shortness of breath, not that other thing you're thinking) so after being dialyzed for 4 hours from 11am to 3am they brought her here and paged me to admit her. But I'm upstairs having carrot cake and listening to james brown and my labcoat is hanging on a hook where my pager (which is on vibrate) is trying to tell me this. So i miss the page by 10 minutes - no big deal right? WRONG. The patient is dead asleep now and I have to wake her from her exhausted state to ask her a mess of questions. nevermind that she's 82 and mildly demented. When I can't wake her I have to write that she is unable to answer my questions. I ask the nurses if she had been coherent. They say yes. Is that good enough. I stress it, I wonder, I delay calling her doc - after all she's sleeping.
And now she's not. It's now 4:58 am and she has just been wheeled in a humongous chair in front of the nurses station because she's AWAKE and they don't want her to wander. She said her holiday was lousy and she won't let anyone touch her and she's yelling she wants to go home. She won't let the nurse check her sugar and she hates everyone except wingnut who offered her a sandwhich instead of a discharge. She poo-poo'd the sandwhich idea, but wingnut is persistent because she can't find the phlebotomist and needs something to distract her - plus she is a well meaning PA. Well who can blame her. At least I know my screaming lady is stable and she likes corn flakes. Why did I take this job???? (I can't believe I'm still awake)



6:50 am
T minus 10 and counting. We survived and all I feel is lucky, tired and hungry. Oddly, it inspires me to so and extra shift maybe twice a month for some extra dough, to tack on another 12 on 12 for a 24 shift as my last. Am i insane or what? Clearly. I chose medicine.
peace out~

Steel Peaks

Glide wanted to crawl out of her own skin, go deaf, grab the butter knife and take it to her own throat; make a bloody mess to mirror the image of what she felt was happening. Slate had asked her here on purpose, the giant wooden slab between them, the metaphorical wall, maw, eternity that she intended to use to bolster her weak explanation of why it was over. The waitress set down two pints and then asked if they were ready to order. Slate said she wasn’t eating and then gestured toward Glide as if to say “did you want anything?” as calm as could be, as if they were just another two people out for dinner and drinks. Glide felt a red hot fury that couldn’t unfurl through the panic and fear, the confusion. Her thoughts attacked her like a mob: ‘Was she really doing this here? She has no plan on staying to finish that beer. This is an execution and my head is on the block. No, this doesn’t make any sense. This is not what’s between us, this is a mistake.’ The words were like rocks falling on her head. “Glide, did you want anything to eat?” she asked, just short of sweetly, oh so normal appearing. Glide looked up at the waitress whose image seemed to waver like the horizon over a hot distance, almost a mirage. Glide felt as if she was going to hurl. She shook her head no and the waitress gratefully disappeared.

When the wave of nausea passed, hope tenuously clung to Glide. She looked up across the table at Slate as she swallowed ale, put her pint down and was about to speak. She loved her, she wanted to reach across right into her chest and show her what was possible, awaken her from her own nightmare. Instead she saw the words gathering like an army in formation, prepared to march, to slay, to defeat and never look back. She knew this about Slate; her decisiveness, her mathematical calculation of emotions. She had been warned long ago and refused to believe this would ever mean anything directly to her. She gripped the edge of the booth she sat in, as if to hang on, to brace herself for the onslaught.

They began - the words, hollow, spilling first from Slate, explanations, simple, reduced, deduced and empty of the meaning used to describe her regret, her sorrow, her need. Glide refused to read the script and rebuffed, gently at first, strength gathering in her with the love she carried in her heart, but all Slate saw were the tears, which she read as weakness, desperate, clinging, and much too much emotion for her taste. Her own emotions were enslaved, locked away somewhere inside her she’d completely forgotten about when the world came crashing around her some 5 years ago. It was her talisman, her shield, her excuse.

As Slate watched the tears fall silently on the beer stained wood, she was vindicated in her decision and her resolve solidified into the sharp edged misshapen shape that it was. It should have been like a thousand year old steel blade being reclaimed by the kiln of Glides love, to be forged once more, folding the two of them 400 hundred times over until the new blade was the love between them; unbreakable and able to cut through all the difficulty life would deal them. But something fundamental was broken in Slate. Glide had seen it from the very beginning and she felt like an astronaut who’d been pushed off into the cold vacuous uninhabitable deep space with a momentum that has no opposition, the sense of Slate fading.

As she slumped to the ground at the edge of the Hudson River, she could not remember how she got here. She desperately tried to remember what had happened. All she could retrieve was the image of Slate as she rose from the table and calmly walked out the door; never looking back. She remembered the tearing sensation inside her, still there, relentless, despite how every other emotion seemed deadened. How long had she sat there? Who paid the bill? What was the point now? The wind rose up and tugged at Glides clothes that were soaked with sweat. She closed her eyes and wept with such force she was sure every vessel would rupture; she wished it would.

She stood suddenly and began running toward the water, tearing through the last wooded section before the precipice. She purposely grabbed branches as she ran, snapping them when she could, the skin on her hands being ripped from her when she couldn't; blood leaving a trail of her intention. The wind rose up again as she neared the edge and with gale force it pushed against her slight frame until she could no longer move forward. It made no sense, this cool summer eve, this wind, but what did make sense at this point. She waited for it to abate without ceasing her attempt to get to the water. It was as if she had walked into some giant web that held her there, tilted 45 degree’s off the earth’s surface, suspended. So focused on the pain and her destination, she didn't realize she'd been there longer than any northeasterly wind has right to blow. Only when she felt the wind inside her did she cease, slumped to the ground and abandoned consciousness, she surrendered; to what she did not yet know.

commercial commerce coersion

christmas is christian, or at the very least catholic. which i suppose i am by confirmation, but not by choice - so not really. i don't believe their stories. but this isn't the day of kings on camelback, these are the times of camelback for hydration by the trendy, the traveled and those who won't slow down enough to really enjoy anything. the television tells me what my loved ones need and where to get it - which i suppose is why i watch so little t.v; rather weild it with dvd's and things that move me. but i cannot escape the ad's on the train, the bus, the paper in the hands of the man sitting across from me - the smatter of chatter of mothers i work with, so far from who i am.

but i love quite a few deeply and the charlie brown christmas, the stories of chris kringle, the humble giving to those in need, to those we love, to remind them of this, still resonate in me. the presents piled under a tree illuminated in the pre-dawn hours, our eyes big a saucers that such booty could be ours, lavished love as toys. this is what i remember when i sift through sellers; picking and choosing the thing that will say what i mean. yes, i still believe in santa, because he's like the buddha, living in all of us who choose to love generously and mindful of our actions.

but i'm still not shopping til next week.

hum

Hum was beside herself, the warm breeze from the water seemed to ripple her emotions, the caps of excitement, fear, arousal, and curiosity folding over and smoothing back on the surface of her only to rise and fall, as if she were all nerve endings, live current. The reeds of the marsh at the lakes edge bent to the will of the wind and as her gaze settled there for a moment, calm claimed her, if only temporarily. The bruised sky was still full of light although the rods would defeat the cones soon enough and shades of grey would announce the night. She still had plenty of time to hike back to the yurt, but couldn’t be bothered to move just yet.

She pulled her legs under her, stretched her spine toward the sky and let her gaze settle in the distance. The din of mental coffee shop chatter began to fade. The sensation of each blade of grass, bent under her weight, pushed against her; each mass settling into one another, equal but opposite forces. As if handling puppies, she let each thought softly wiggle, lapping at her, then gently put them down. Her edges ached and she had a moment of impatience, always at this point before passing through where her body seemed to disappear from her minds eye.

She was the fickle breeze, she was the generous reeds, she was the deep still water of the lake, she was the metal of the sky, she was clear and clean when she felt the electrons jump, all flipping to polarize, vibration subtle but true. ‘What was this? Let it go’ As if some obstacle dressed as desire, she wanted to reach out and grab it, but didn’t want to leave this place it was so hard to get to. She pulled the reigns on her mind taught. It felt like the deepest string plucked, the wooden box pushing it back out into the world through her. As if a butterfly landing in her open palms, fluttering, soft and about to take flight any second. She wanted to open her eyes, the base desires rising up in her; want, impatience, possession, longing. She could feel her hips, as if bone grinding on bone. No she commanded, not so much in her mind as her center. She let it go, stopped trying to wrap herself around it and that’s when a hot liquid spilled, beginning on her shoulders, as if atlas. It soaked her, gliding down her back, around her sides, through her spine, pooling in a place that she could never describe. It was like sex, like fire, like shouting, like drowning, like nothing she could name.

She blinked as she felt her face cupped by a soft warm hand. She was alone. The sky melting into the mountain peaks, the air pulled from the north and a shiver ran through her. She looked around her, sure that someone had been there; pulled her rudely from her meditation. But there was no where to hide for a mile in any direction and the call of the loon brought her fully back. She rolled her shoulders and pulled herself up to her full 5’10’’ frame, as if unpacked from a box come cross country over weeks. She began to hum a tune she’s never hum before, born of the lush green hills where her grandmother’s grandmother was born a yesterday too far to touch.

from the rubble

“It all depends on how you look at it”, She said.

“That’s bullshit” he replied, “You’re just justifying your actions”.

“No I’m not. Think about it. You have a guy who ties a bomb to his body, runs into a crowded public area and blows himself and everyone else up” she started. He stared at her blankly, almost as if he'd just been slapped, failing to make the connection. She continued, “He did it because all those people in that square support a government that say its o.k. for their armed forces to rape and kill his people because of who they are and where they live, when they’ve been living there all their lives. Is this guys a terrorist or a freedom fighter?” she queried. He raised his eyebrows knowing what was coming.

“You’re kidding right?” he stated.

“No, I’m not. To his people he’s…” she trailed off.

“Yeah, yeah, yeah” he cut her off, “I know where you’re going with this. But it’s not the same” he said rolling his eyes at her.

“You only say that because that’s not how you look at it”, she said smirking satisfactorily.

“I shoulda seen that one coming”, he said smiling.

“All done” said the tattoo artist.

“Nice” Siobhan breathes in a whisper. “What do ya think?” she asks Ryan.

“Very nice. Ready?” he asks.

Siobhan paid for the fresh artwork on her right upper arm. She gripped Jo’s hand and pulled her chest to chest in a familiar embrace. “Thanks Grrrl. Beautiful as usual” she said shoving an obscene amount of money in her hand. Macha, drawing her sword, eyes glaring out at the world, much in the same manner Siobhan was prone to doing, beautifully replicated onto her skin. Jo tried to object to the ridiculouly generous tip, but Siobahan wouldn't have it. "Can you put a price on art?" she said to Jo and backed out of the shop smiling, with Joann smiling back at her, palms pressed against each other and bowing slightly. She and Ryan made their way back to her loft in DUMBO. As Ryan climbed off the back of her bike he fiend fixing his hair and batting his eyelashes at Siobhan. She just giggled at his hulking 240 lb sculptured body acting like a 15-year-old girl.

Once upstairs, Siobhan drew open the long white curtains framing the huge picture windows facing the East River as it pours into the bay. The apartment lit up as if unvieled, light spilling in despite the gray clouds looming over the city. Ryan turned on the stereo to find Stevie RayVaughn wailing away his Texas style blues that immediately put a smile on Siobhan’s face. After a little air guitar solo, she brought him some water and collapsed on the sofa across from Ryan with a satisfying 'flump'.

“So” he said leaving an opening for her.

“Uhg…can’t we talk about something else” she requested.

“No. I want to know what you intend to do. You know Mari’s birthday is nearly here. You’ve already bought a ridiculous amount of presents, as usual, and yet you’re sketching images of this other lass. Where is your head?” Ryan asked.

Siobhan grabbed her face and threw her head back with a groan of frustration. “Ryan, I just don’t know,” she mumbled into her hands.

“You talking to me or yourself” he asked sarcastically.

Sitting up and glaring only to receive a big smirk in return from him, she defended, “I love Mari. I have loved Mari for years. Of course I bought lots of presents.”

“And the sketches…” his words left hanging in the air.

Siobhan was silent for a few moments, thoughts of Alex running through her head. Her beautiful smile, her unabashed laughter, her bullshit free conversations, the way Siobhan felt when Alex would casually touch her somehow flirtatious without towing her into betrayal …well not by the letter anyway. Alex at the beach, Alex on her Harley, Alex in uniform, Siobhan was gone. “Hellooooooo, there was a question there?” Ryan jarred Siobhan from her reverie.

“Oh Ryan. I cannot stop thinking about her. I know I don’t know her, but I know her. She makes me feel…on fire, alive, free.” Siobhan blurted.

“Didn’t Mari do the same for you when you met?” he countered.

“It’s not the same. New is new and all things new burn fresh, but... I mean, Mari was new once and then more, and I love her now; but I promise you, this is something entirely different and has tilted my world just enough that everything seems to be sliding. This isn’t just new, and yet I feel new. There’s this…I don't know....connection between us that there just aren’t any words for. It’s as if I’ve known her, which I obviously haven’t or like I’ve found someone I knew I was about to meet, but couldn't have known, some kind of deja vu but less hokey...” She said groping for the right words.

“So you lie to Mari, cheat on her and if what you say is true, eventually leave her. Nice.” He said sounding disappointed.

“No. I don’t want to leave Mari. I don’t feel I’ve lost anything, I mean not that wasn't already missing. I mean I know we have our own shit today to deal with, but it’s not related. You know I’d tell Mari if I could but I’ll end up in the street. She wouldn’t get it.” Siobhan said exasperated.

“Maybe there’s nothing to get. Maybe you’re just romanticizing this for your own benefit and you’re simply a cheat who wants her cake and eat it too.” He offered.

“Some friend. Do you ever listen to anything I tell you? The time I spend with Alex is free from expectation. I’m not thinking about how to swoon her, how to get with her, what comes next. I’m simply there, present, enjoying the moment. She doesn’t want me for herself; she just wants time with me to share whatever connection it is we’ve got. The only want in tomorrow is for more time with each other.” She explained, but as she trailed off her brow furrowed thinking there was no way to find this in her life with Mari. Mari was filled with expectation, and shouldn't she be? It 's how Siobhan has always been with her, filling her expectations. And how do you change midstream, how do you explain that something in you feels as if it's been free'd, made anew, by someone else?

“Look. I don’t always understand this free spirit rubbish you spout, but I can appreciate it. Still, how can it work when Mari believes you are hers alone. No one wants you to be happy more than I and it would be different if Mari knew and agreed with your life’s philosophy or even knew things have changed for you. But can you really love Mari and spend time with Alex, having to lie to Mari? I don’t know Siobhan. I’m just worried about you…and Mari. I’ve grown to love her you know.” Ryan finished. Siobhan stood staring out the giant windows the gray clouds turning darker. The conflict between Mari not knowing how she felt about this aspect of life and trying to live the way she thought her life should be. She growled at the sky and turned staring at Ryan.

“What?” he asked feeling cornered suddenly.

“I appreciate your honesty. I’m not trying to be a dick. I don’t know what to do. You know me, you know I’m not just trying to get one over one Mari” she started.

“I know, I know. I didn’t mean that. I just want to you to try and think clearly about this one. Be good to Mari. “ he was saying when the intercom buzzed and Mari’s smiling face came up on the screen. “Speak of the devil,” he said.

Siobhan buzzed her in and moments later sat listening to Mari tell her about her day, with Ryan gone and promising to finish the conversation later. Mari’s words were clear, but Siobhan’s thoughts were not. A flash of brilliant lightening lit the sky and appeared to be a premonition to the coming days.

seconds slipping

always this wretched conundrum about the seconds bound, in a day
and now i'm too damn tired to write
fresh this morning, gazing on sleeping figures, in a row rocking gently as if basinets in a nursery, gentle faces
the sun threatening the horizon as my ride rattles onward north,
two young men, never quite meeting gaze, palms graze smoothly in greeting that is allowed
the rasping gasping breath of mrs m, her brow furrowed like sand dunes just before the gust that flattens them, giving way to a smile for taking the time to explain what the herd of big brains would not, they never see them though they claim them as purpose
mi amore, mrs q at 99 years young, a light too bright to be extinguished
asking only and simply to go home
the gentle vibration in my pocket, a whisper distraction that makes me smile
in the hustle of my juggling act with lives, deft hands, near total focus, dropping nothing
the wonder at how i always seem to surface, just as the bustle to home carries me with it,
how easy it would be to drop into a deep sleep and end up in marine park, much as i love the ocean
i'm glad to be crawling in my own bed, the last chord still humming in the air
as she hangs on the wall,
me alma

blurred lines

which is more important: to have people fulfill some equivalent criteria for what we value as important and right, or to be able to see what is beautiful in them and love them flawed and all? surely there are lines we draw, rightly so. there are things in my life i value and won't compromise, but it's a damn short list because i prefer possibility and i think room for growth only comes with an open heart and a good sense of humor.

during one of the most challenging times of my life, i was thrashed about in a sea of brutal wave after wave after wave of not water, but information. some people are better swimmers than others and i freely admit that it's dog paddle or drown for me - except i can tread water for a damn long time, and anyhow, i love the water.

she stood apart from the get go, and some folks bristled at her demeanor. she knew it, but sometimes it's this simple; we are who we are. i think she said something sharp one day, and i laughed. maybe we knew we'd be friends then, maybe it happened when i placed a clementine orange at her seat, a gesture that maybe surprised her. the smile that is proprietary to small children who have no use for defenses or facade is what blossomed on her face as she looked over her shoulder at me. things are not as they seem.

when i think back to that crazy time, it seems truly a lifetime ago. but i can still see her smiling, a scarf wrapped around her face, earplugs in, ignoring the lecturer and studying something else - the occasional smart ass text message popping up on my screen one row behind her. we'd try hard not to giggle out loud. i can remember as well the pained look on her face, when she couldn't look me in the eye for fear of expressing her thought of betrayal and that i could be on the other end of it - confused, she didn't want to believe it and i didn't understand and was hurt that she might think it of me. but i knew to give her room, let the dust settle and wait it out, because we were friends and things like this don't break friendships - not real ones, and not this one.

so why did i walk away without an explanation? a comment, text on a screen, rife for misinterpretation. an inappropriate remark that seemed so selfish, so harsh, so fucking wrong. I couldn't let it go, I refused to reply, I backed away - it was easy(er) from 3000 miles. who would say such a thing? did i want to be friends with someone who would say this? there are some lines we draw and rightly so, i thought.

the problem, i see now, was the sharp lines i inked; the rigid, unforgiving lines i stood on the other side of. if it meant that much, if i was to truly tow the line, i would have faced her and opened the door to explanation. i was offended, i shut the door on her. flawed, we are all flawed and all that's left to mend these bit and pieces is the very thing that's been the ground under foot the whole time; love.

from this quiet late night brooklyn apartment i am kept awake by the realization, clear and softly tapping on my chest, that it takes much more than a fucked up comment to crush love and that i can either toss it to the wind and continue to look east, or open that door. caught quite unaware with nothing to lose, i am pulling the pins out of the hinges. all you need to now my friend is walk through it.

309.81

I am a health care provider.
I am a human being.
These two things are not mutually exclusive, gratefully.

Medicine is often described as having 3 different facets; it is an art, a science and (disgustingly, but true) a business. As with all businesses, there is always the bottom line; profit. Tracking how to bill for pills, procedures, exams and evaluations is a complicated task. The billing of medicine is tracked through a somewhat organized system between illness/disease and procedures. The codes for the first are called ICD codes, the later CPT codes. I forget what that stands for, as I do try and remain as far from the business aspect of my profession as possible. I am especially irritated by the connection between healing and profit, but this is a rant for another day.

This morning as I was responsibly and routinely paying my bills, i came across a handwritten invoice from my therapist. My internal reaction upon seeing it was the antithesis of spying any other bill. The handwritten notice itself reminded me of how much I appreciate, adore and respect this woman. She has given me language for emotions I could barely name and showed me how I could navigate myself out of the most difficult times of my life, both past and present. When I flipped it over I noted the ICD9 code at the bottom of the letter; 309.81 because of course the insurance company would need it to pay it. With the curiousity of both a small child and a medical nerd, I wondered how I was being depicted via this numerical code, so I looked it up and found this:

309.81 Posttraumatic stress disorder
Chronic posttraumatic stress disorder
Concentration camp syndrome
Posttraumatic stress disorder NOS
Excludes:
acute stress disorder (308.3)
posttraumatic brain syndrome:
nonpsychotic (310.2)
psychotic (293.0-293.9)

The definitiveness, the concrete boundry in this code, let alone the pairing with 'concentration camp' pulled at a thread in my steady morning and unraveled me. Was the other end of this thread tied to some ghost of steel and dust laying in the landscape of my memory? Or did it go farther back to a place and time I still winced at? The origins hardly mattered, because I knew this was not a descriptor of convenience, it was not simply for the insurance company- it was part of me, it is part of me. I forget most days in the way we forget what our feet look like, though we can always look down and there they are.

I do this the same thing, every time I am faced with this. I compare, I diminish, I try and squash it into an impossibly small box. I am not being shot at in the gaza strip daily, I am not being raped in darfur, I am not drowned in a tsunami, I am not in a refugee camp or guantanimo bay for that matter. There are so many other trauma's worse than mine - and no matter how many times I think this, strangely, my shit is still there. I laugh a little at this exercise in futility. How many times do we fall in the same hole before something in our synapses fire and tell us as we approach the gap that it is there; WALK AROUND IT FER FUCKS SAKE!

But I'm describing rather than addressing my reaction to this metaphorical slap in the back of the head, and maybe it's because I still lack the language for it. Maybe that's a total cop out and I still turn away from it just because it's like wool underwear and I need to go underwear shopping.

friday afternoons...

They told us in school that friday at 4:30 the shit would hit the fan. It's when all the patients wanted/needed something and the clinicians would be trying to go home, go to their weekends, to no avail. We all laughed at the stories, after all they were just stories.

This morning was a smooth morning, 5 patients in all and it seemed that only 2 were new and pretty low maintenance. At a morning break I jawed with another new PA and we talked about things felt calm and we would be leaving on time today, yeah baby. Yeah well, it was friday, and around 3 or so, things started to stir. It felt ok at first, after all, I'd seen all my patients and now it was just a matter of follow-up and management until 4:30 rolled around. And as the minutes ticked by, and 4:30 loomed larger, the winds of fortune were gathering speed and about to whip my ass. The woman who was supposed to be discharged yesterday, but sweet talked her way into one more night away from her job and bustling house, was constantly asking her nurse for a letter stating her hospital stay - a small task. The woman who were worried had a PE was itching to go home and with the negative V/Q scan, that seemed just fine, except her coumadin level was still subtheraputic, she has a history of PE's and she still wants to go home and shower and change, not stay and let us bring up her levels - she was threatening to leave. Hell, I would too, cuz the shit was starting to stir. The man who had been ready to be discharged for days and days, sitting in our bed instead of his bed, was baseline bewildered beside his wife who had lied about her insurance coverage and now cried innocence when the care he would require cost near $700 a month (from a company she continuously failed to pay and now wanted more services) and passively blamed everyone for her inability to take her poor husband home. "Put him in hospice???? That's how he got the bedsores that brought him here!!!" They were deep and ugly and even I winced upon seeing them today. How can they pay for him to be in a hospice, but not some simple care in his own home with me??? She chewed the ear off anyone who would listen, and I was her husbands PA. The gentleman I had seen very early this morning, who probably had some aspiration pnuemonia required some consults and getting consults on a friday is tough business. But I'd started early, I knew better, even as green as I am. Still, the doc showed up right aroun 4:30 while I was trying to put out the biggest fire yet, and she had a whole slew of orders. Who cares that I'm done now, I'm still here and I'm his PA. All new orders, changes to others, customs orders, things I'd yet to do. And the creme de la creme, poor Mr C who's son was getting married tomorrow. He lives in Puerto Rico but he used to live here. He went for a check up while in the states, after all he had his heart valve replaced here. The doc found him anemic and decided to work him up as an inpatient. Don't worry, we'll have you out by friday - the wedding saturday, the flight home monday. We assured him once he was back from his colonoscopy, if all went well, he'd eat one meal and then be discharged. But here was one of the cardiologists on the phone, incredulously in disbelief that we would even consider sending him home today without anticoagulating him for 4 or 5 more days - after all, he has a mechanical valve and has been off heparin all day! What were we thinking???? I go to break the news to Mr C after explaining and advocating for him to the cardiologist. His jaw hits the floor and then sets tight in anger. He's been here all week and we're gonna tell him this now??? Even I was with him yesterday and told him all about how he'd be going home afer his scope - it's what the senior PA told me. Fuck, fuckity, fuck and fer fucks sake. We got the cardiologist on the phone directly with Mr C, his wife shows, they both do their best to be cool, but the floors been taken out from under them. It's now 5:15 and I'm not going anywhere soon. It's friday.