sample chapter

Chapter 6

A Special Kind of Knowledge

It’s Tuesday, late in the afternoon during the second year of my clinical rotation, and I’m looking out the window on the eighth floor of the hospital. The sky, a hundred shades of dull, looms heavy with the ever-present smog that clogs the urban air. An eerie wind rattles the panes of glass as I peer down on the scene below. I’m watching the cars as they pass under the walkway connecting the medical school with the hospital, and studying the clumps of people shuffling about lost in their own thoughts. I am thinking about my plans for the weekend, and my uncomfortably tight uniform with its high-waisted pinafore and too-narrow neckline that pinches my neck when I move my arms. Mostly, I’m stalling for time.

My feet feel super-glued to the floor. My legs are as heavy as my spirit as I contemplate the task ahead. This is new territory, and my stomach churns. One of my patients from the rotation in ICU has been transferred to a regular room on the neurology floor, and I’ve come to see her. She’s twenty years old and paralyzed.

I was working the day Carrie was admitted to intensive care. Her serious injury resulted from a freak accident during a routine shopping trip on a snowy day. A winter storm had transformed the frosted asphalt into a treacherous plane, and Carrie’s husband’s pickup slid on the frozen slick and swerved, slamming her head sideways into the passenger door window, snapping her spine, rendering her body and limbs numb and motionless. Surgery would strengthen, stabilize, and realign broken bones but nothing more. The damage to her spinal cord at the level of her sixth cervical vertebrae happened at the instant of impact. Her paralysis would remain permanent. She had forever lost the use of her legs and hands.

I’d watched Carrie’s during the first harrowing hours as she awaited surgery, when everyone was still hoping for the best. As a new student, I was once again a quiet observer, unsure of how to participate as doctors and nurses hustled around her bed administering care. Her young husband also stood by in stunned silence—tears welling, his form slumped against the heater under the window, eyes blazed wild with fear and disbelief as he struggled to make sense of his sudden immersion into the alien world of sickness and disability.

Paralyzed. The facts concerning Carrie’s devastating quadriplegia and what it meant took me by surprise. I’d heard of paralysis—Roy Campanella’s injury in a 1958 car accident, Jill Kilmont’s skiing mishap that hit the newspapers the week her picture was featured on the cover of Sports Illustrated. But the devastating, irreversible nature of their plights never registered. Pressure sores, urinary catheters, bowel programs, and spasms—these were now part of my new and ever-expanding medical vocabulary. This knowledge plunged me into reality from a totally different point of view. Caring for Carrie’s broken body over the course of her days in ICU, touching her and being touched by her, was bringing paralysis up close and personal.

At my post by the window that November day, I’m aware of my own fear. I’m scared that the sadness and horror of what’s happened to my patient will overwhelm us both—afraid of the places my mind goes without a conscious effort toward restraint. I picture myself in Carrie’s place and the terror and despair of being unable to move, feel a touch, or control bowels or bladder, knowing that I never will again. These thoughts are so uncomfortable that I’m compelled to move on. I finally turn and enter the patient’s room.

Carrie lies face up and motionless, her passive body sandwiched between the two canvas slings of a metal bed called a Stryker frame. A bag of amber liquid hangs on its side. I bathed her during her long stay in intensive care, and her dark skin, familiar and unblemished, peeks out from an opening at the front of her flowered gown. Her hair is thick and long like mine, but a matted mess from weeks of neglect –her scalp still orange and crudely shaven at the temples where metal tongs pierce her skull to hold her head immobile.

I stand back as two attendants come to turn her—one standing at each end of the bed, counting to three to coordinate a quick flip. Carrie’s body shifts slightly with the weight of gravity as the metal frame is turned. Overcome by the sensation of falling, and unable to exert any muscular resistance to alleviate her helplessness, she screams as she’s rotated like an animal on a spit, the metal tongs tugging at her temples. One leaden arm falls, and she’s powerless to stop it. My own scream is noiseless, caught in my throat, forming a lump that travels to the pit of my already queasy stomach.

Carrie is lying face down now with only time to spend studying the green and white squares of speckled linoleum beneath her face, so I crouch on the floor by her head and look up. She smiles and greets me without a hint of sadness. “My husband’s promised me a new wardrobe,” she says too quickly, “when I’m up and walking again. Mom’s watching the kids.” She pines for her two young children and chats about their activities. She worries that her mother has more work than she can handle. She complains about the hospital food. I listen and nod. My mind scrambles for a reply, but words sink before they’re spoken. Thoughts of wardrobes, activities, and food float like helium balloons up to the tiled ceiling and then drift away. When my silence finally breaks, I succumb to the very human urge to respond to another’s suffering by telling about some of my own.

“I broke up with my boyfriend,” I offer, regretting the words even as they fall. For a moment we’re quiet. The air seems heavy. This was the wrong thing to say.

“Maybe you’ll get back together,” she says with flat hope, her face to the floor. Our eyes meet in uneasy knowing. We live in two different worlds.

Once again I’ve positioned myself by the window. It’s evening, and the cars on the street below have turned on their lights as commuters scurry home—everyone busy, full of plans, activities, and places to go and so unaware of the suffering here. As much as I want it, there will be no happy ending. Nothing can change that.

“I think I am able to move my toes,” she says.

Over four decades later I still hear Carrie’s voice and recall those words. I see myself at the foot of her bed, glancing out the windows with darkness closing in. I don’t know it, but this is a pivotal moment. I turn. Time loses meaning as I stand head bowed, tentatively looking down at the bottoms of my patient’s feet. I’m waiting, even hopeful, staring at her bare soles and frozen toes. Her feet aren’t moving.

And then I know. Pain can be palpable as it moves across the space between two people, molten, unrelenting. Like joy and laughter, it’s quite contagious. This is the special kind of knowledge I wanted, even craved going into nursing school, and yet it’s not at all what I expected.

And this lesson will be repeated again and again and again. Shared pain is still pain. Some sadness will never let you go.


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