Tuesday, July 8, 2014

EMERGENCY ROOM ZEN

Working in a hospital emergency room I have plenty of opportunities to show compassion. In fact, I consider the ER to be the lazy man's way to practice: everyone who comes through the doors is scared or hurt so any simple act of kindness can make a profound difference. I'm kind of a slothful Zen practitioner and as I see it, this work is some easy good karma-making. Frankly I'm also an adrenaline junkie so being front and center in an emergency (read: a situation where no one knows what the hell is going on) just feeds that mojo. A lethargic Zen practitioner adrenaline junkie. Go figure.

Some days the ER is like Dante's Inferno where there's wailing and pain everywhere. Other shifts can be like watching television: insipidly boring. There's a red light that goes on by my desk when a new patient enters triage. It's cool, because you never really know what's out there. Great mindfulness practice, just being, being ready, and waiting. And again, I can easily end up smelling like a saint just by clocking in. Lazy Zen.

There was the 21 year old kid who knew he was running out of insulin but thought he could hang on for a few days until his new insurance kicked in. He had no money to buy his resupply. This didn't work out so well, as any insulin-dependent diabetic will tell you and lo and behold the poor guy spent the night in upheavals and spasms of mighty vomiting. By the time he found his way to us he was exhausted, dehydrated. He was still puking like it was his job and his stomach would cramp so deeply that his pants would fall down. He stunk, as you might imagine.

We got him onto a bed and I helped get his clothes off. I'm just an EMT, not a nurse, and much of my work has to do with stocking supplies, communicating with other departments and docs, and answering the phone. When I do get on the floor to help I do the scut work the nurses don't want to do or don't have time for: undressing the patient, taking vitals, getting urine samples, putting in IVs, cleaning wounds, applying splints. Except for the IV part (I sure don't like it when I miss, and you don't either) I love every single part of patient care.

After I disrobed this young man who probably would have been embarrassed if he wasn't so sick, I saw how he was shaking with cold. This is such an uncomfortable feeling, uncontrollable freezing. Our hospital is in a ski resort so we have an unlimited supply of toasty blankets. I put two on his shivering form, curled up in the fetal position and I thought he would cry with gratitude. The nurse gave him the meds that made the puking stop, and then I cleaned up his crusted mouth and washed off the vomit he had managed to get on his legs. Simple, easy acts of kindness that made a very sick kid feel better and grateful. This is why I say the ER is the Lazy Man's Practice.

I don't mind taking off a person's dirty shoes, washing their feet and putting on those goofy hospital-tread slippers. Sometimes older folks are shy because they think the smell (and they do; we all do) but I'm cheerful about it because what the heck. I'd much rather practice "easy' compassion in the ER than deal with my husband's cranky moods or listen to an irate friend go on about some perceived injustice. The regular life stuff is much harder than washing feet in the ER, believe me.

Now, not everyone is grateful for help or comfort and this is part of the gig as well. I'm not looking for thanks or kudos though that's nice and gives me an ego-zing but mostly I'm just doing my tech job, going about my business with a cheerful mind which is a little incongruous in the situation. I don't cry or get angry often or go to any extreme emotion, thanks to some solid years of sitting. If the ER pushed buttons like that I'd be exhausted and depleted. As it is, I'm mostly curious.

Sometimes the drug seekers can be a real pain in the neck. They curse a lot and are always jonesing for something strong and like most addicts - like all of us - they can be so mean and irritable while awaiting their fix. Every time I pass the bed of a druggie or "crazy person" as we in the field say I try to sneak by so they won't start yelling at me about how much it hurts. I'm not so much with the compassion for the addicts and the psychos. They're like our very worst selves, manifested right there in Bed 3. Who wants to look at that? Nah, I'd rather soothe myself with the whole Mother Teresa routine and go help the scared 12 year old with a displaced fracture.

We always ask patients if they've taken any drugs, medications, or alcohol and surprisingly they often tell the truth because they're pretty scared.

"The truth is just easier," one exhausted drug seeker told me, "I'm just too tired to lie."

Generally, I don't much like the cranky unhappy sick and traumatized folks, just like I don't like the cranky unhappy healthy ones. The ER is a microcosm of the outside world, and people have various methods of dealing with pain and fear. I like compliant and grateful, not obstreperous and miserable. Just like the world outside those doors, frankly I'd rather not do the hard work. So cleaning up a dirty alcoholic or helping an old man pee in a cup - easy Zen.

Here's the thing, though. There is hard science to prove that the presence of calm can have physiological benefits, just as the opposite is true: stress can create the perfect storm for disease. A calm presence can lower blood pressure, regulate breathing, and release healing hormones. So a Buddhist in the ER seems to be a good idea. And for the Buddhist, it's an amazing place to practice.

When someone dies on my shift it's often related to trauma; if it's medical we try to get them out of the ER - on a flight or to the ICU - ASAP so they don't expire on our watch but when a person gets hit by a truck or a skier meets a tree head on, they can die right there in front of me. As an EMT I've seen a lot of the mortal wounds the flesh is heir to but death still catches me short. It is phenomenal, truthfully, to watch the breath leave the body. As practitioners we are all about the breath, right? Who are we then, when it stops?

I sometimes have the work of cleaning up a dead body before the family or coroner comes and we all attend this task with quietude and respect. I pick up an arm to move some tubing and it's a lifeless appendage. The dying person is strewn across the gurney, often naked and bloody, all that is left. And nothing is really there; just an earthsuit, a bag of bones.

Aside from the scared, sick, dead, and dying I have all sorts of co-workers. The night doc has a great sense of humor but a precision-sharp attention at the bedside. Nurses come and go, some attentive and compassionate, a few just lazy and biding time. As the unit secretary I know a lot of the folks in other departments - respiratory therapists and X-ray technicians, administrators and housekeepers. I love the housekeeping staff because when the shit hits the fan - often quite literally in the ER - they show up, uncomplaining, with their swifters and buckets and they just clean up the mess. Laundry folks are the same way. We amass a crazy amount of bloody sheets and used blankets. How could we function if those big yellow bags of dirty laundry never got emptied? When I thanked a laundry tech for her help one day she looked surprised and then said simply,

"Well this is just another way of taking care of people."

See why I like the ER? It's people at their worst, and at their best, spewing fear and courage in equal doses. We're sick, we're healthy; we're in pain, we feel better. It's the whole catastrophe as Jon Kabat-Zinn would say. It's the two year old boy getting stitches removed who screams in my ear like a rock star while I hold his arching body still. I love the fight in kids because I can also be such a two-year-old: I want it MY way! And it's hilarious to be reminded of that. Most parents are paralyzed with fear when their kids are in an ER so often I pay more attention to the suffering mom than the squirming curious patient. A doctor or nurse doesn't have the time or inclination to do what I do or see what I see and that's fine. Not to sound all holy but I am happy to do the menial stuff unnoticed. It's actually fun.

Spending a ten hour shift in a place of emergencies I'm fortunate to see fear up close all the time. It's like watching a very scary movie - it ain't happening to me but at least I get to practice the terror. I am constantly reminded, too, of the transitory nature of this silly bag of bones. Lord, I do see the stinky side and when older folks come in I notice how transparent our very skin gets as we age, like we're getting ready to shed like a snake.


Dainin Katagiri, a profound and amazing Zen master, writes that every moment of our life - every moment - should be treated as an emergency. And by that he does not mean we should be lost in constant anxiety. Rather, every moment we should see as fresh, new, expectant, and requiring of us complete attention. When the ambulance tones go off in the ER the staff alerts like deer to an oncoming car. And this is a cool way to live, one brilliant emergent moment at a time; not knowing what might hit or when, but always being ready, alert, being there with eyes open.

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