It started out as fire play. Trying out the new Blaise stick Tutivillus was given at Thunder by Simon Blaise. It is a very pretty stick. It fits Tutivillus. It is stainless steel, gothic looking and heavy. And claws. Sharp claws. Fire play is warm, it is nice. The flames lick at your skin, dancing lightly and are brushed away quickly before any damage to the skin is done. A sensuous activity that still requires trust. It is more sensuous than painful. I like pain, I like sensuous. I like this stick. He would put the flame to my skin, the flames spread where the alcohol had been smeared, wipe it away gently and at times use the spiked claws to scrape along my skin, putting sharp edges into crevices and open areas. Mainly my ass. He thinks it is funny to tell me not to move and poke my ass with sharp things. Of course I jump. Might be a little funny. I would think so if I were standing there poking someone else! My skin is becoming red from the flames so he decides to use his new sword, not big enough in width to be a machete but sharp. I feel the blade up and down my spine, occasionally slapping my back. I like the slapping, it is thuddy. The blade caressing my skin is sensual yet painful, a scraping type sensation that feels like a knife carving into my skin. I like this sensation. I like the cutting feelings and sensations but limit this activity as I am a little vain. I do not want scars all over my body. I limit them. But the sensations of it, yes, I like that! I feel the thuddy sensations and am really starting to relax even more. I am starting to see the room become a little darker and more cramped. There is a few people standing around. A woman is in a smock dress. 1950′s type with the apron and flowers. Blue flowers, white background and green leaves. It is old, worn and tired looking. There is a frilly pinafore on the chair, pink, with white lace. Little blue flowers, small flowers, not the big ones like the ladys dress, this one is a childs size. Hanging neatly over the chair with small shiny black patent leather shoes, they look like new, sitting beneath the chair. White tights are slung across the seat, almost like they had once been alongside the dress and had slipped down into the seat. No one had straightened them. There is a large cylindrical tube that I am feeling around me. I can’t move my arms very much, my hands can only wiggle a few inches to either side and up and down. I am laying on my back with my head poking out of the top of the cylinder. My lower legs are poking out of the bottom. I can feel each breath pounding, each one pounding harder. The more it pounds, the more I want to move and cry. I am told to hold still. The stern voice of the one running the machine, sounds like they are trying to be unemotional in their commands. But I can hear the choking back of sadness in their voice. It occasionally cracks as they speak. They are feeling conflicted. Does the pain really help or is it just delaying the inevitable? Disassociating from the little girl of about 8 laying in the big tube, her small frame made even more small appearing with the large metal tube covering most of her. I realize where I am, I am in an iron lung. I did not realize how painful this would be. Each breath feels like it is taking the wind out of me. Pounding my back like it would throw me across the room if I wasn’t held in place with the giant tube. I am crying, and kicking. I can’t kick very well, but I am doing my best. I try kicking and screaming. I want to kick out of this thing.
The pounding again. Thud thud thud. I am aware of the pounding on my back, I am in the dungeon. Tutivillus is hitting me with the sword, I think. I can’t tell if it is now a stick as it is thuddy. I like the thud. I try to tell him I like that. I am not sure if I say anything as something catches my attention. I see me. I am doing CPR in a hospital room. I recognize the room, I recognize the people who are doing the code with me. A boy of early twenties. Was drinking a few drinks with friends in the canyon, the ski resorts are closed, it is spring. The runoff is moderately high. The water is cold. Freezing. He is trying to be responsible, drinking in a campsite with friends, not driving, planning on camping over and driving home in the morning. He thinks he hears something, a dog or cat? Unsure he gets closer to the rapid stream of the bulging river. The ground is wet, he is a little tipsy. Not used to the tipsiness maybe, maybe just a wrong step? No one will ever know for sure as he slipped and fell into the river. Friends run, can’t get to him as he is pulled down stream. Emergency help is called. It is 45 minutes from the time he fell into the river before he is able to be pulled out. CPR is started immediately. He is able to get his heart started again, he is brought into the unit I am working. I am charging. Overseeing all the staff on the floor. The trauma unit is busy tonight. We do CPR multiple times. He is cold, the heart is very irritable when it is cold. The brain doesn’t like being warmed very quickly, brain tissue is preserved with the cold. Warming him slowly but not too warm is the goal. He is banged up everywhere. The river is an equal opportunity menace. The freezing temperatures, the many rocks, stumps, trees and branches as well as swift water tearing at all flailing limbs doing multiple traumatic damage to the entire body. His face is barely recognizable. We bring parents in, the staff is doing everything thinkable to try and save this boys life. It is unsuccessful. Three and a half hours of “coding” him, getting a heart rhythm back, trying to oxygenate his fluid filled lungs, losing his blood pressure and heart beat multiple times it is finally called and he is pronounced dead. The family has stood in the corner of the room watching this. I go to talk with them. Try to pull myself together as tears are trying to fall. I won’t allow them, not in front of family. They need professionalism, they need comfort that everything possible was done. Ironic as the family began to comfort the staff. Thanking them for not only doing all they could but for caring and feeling for him also. I am now looking at another patient in a bed. A different room a different circumstance. There will be no codes in here. This man “Michael” was in a parking lot. Drug by a car as they drove away. Were they trying to get away? The car ran over his head. Story remains unclear whether it was a drug deal gone bad or a drunken “darwin” moment on his part. No heroics, the CT scan shows too much damage to save any resemblance of life. The mother and girlfriend are here. Waiting for another friend to arrive. The one who hasn’t been allowed in. He was the driver of the car. He has been in custody while they have tried to piece together the story. The mother was the one who decided his fate. “He was a good friend, they drank a lot together, I believe it was an accident.” The police dropped all charges, he is on his way to come say good by to his friend. The ventilator will then be removed, he will be allowed to die. Many staff are curt and blunt to the family. This is my third shift with him. I was here when he was brought in, I will be here when he dies. The family is very hard to talk with. Very un-trusting of staff and their motives. They have seen the wrong end of the law many times in their lives. Healthcare personnel are usually put into a “side with the law” category. Utah is also known to have a very low tolerance for people who do not conform to the common mormon religion. Our unit has a very high non-mormon ratio for this community. But the judgments of some stand out as it is expected in this state. I take care of this patient the way I do most of them, I give them my standard of care and also try to give them some respect as a person. Many forget that although they are not really there, they are still a person. I am also one who believes the person and the body are not one and the same. I did feel him standing next to me at one time while I was giving him some medications. When he died, no one cried. The family had said their good-byes and did not want to be there when we removed all of the equipment. People deal with death and dying differently. Choosing to be with a person as they die is personal. The only comfort I could give to the family was that it was ok to leave. They did not need to stay if they did not want to watch him die. Being at the bedside for a persons death does not tell anyone how much you loved them, the way you treated them in life is what matters.
The thud thud thud began again. I am thrashing as much as the big metal tube will allow. Damn, it is starting to get stingy… The feel of the pounding becoming increasingly stingy due to the repeated hitting of the skin in the same area. Extremely stingy. And painful.
I look in another room, a young girl. Seventeen. She is very pretty, from the hallway walking in she looks like my 16 year old daughter. Blonde hair falling over her face, she thrashes about. Confused, talking nonsense and her whole body hitting rhythmically into the rails of the bed. She arrived a few minutes earlier, here on a trip for a beauty pageant. She was a contestant. Started running a fever and a headache. Laid down to rest, her neck then started hurting. Her mother was called, she brought her into the ER. Within a 45 minute period she went from telling the story of her headache starting and her neck starting to hurt shortly after, and her feeling just very hot, to flailing, confused, unable to speak or acknowledge anything. She arrived to the ICU room tied down to prevent her from hurting herself or falling off the gurney. Upon moving her to the hospital bed I put the rails up, took the restraints tying all four of her limbs down off and padded the rails of her bed with blankets and pillows. I put a large sheet across her at the waist and tied it to the bed. She could thrash and turn and move, but could not flip out of bed. Her mother was at the bedside. She started crying. We talked. She was very appreciative of her being untied. That was very difficult for her to witness. There was not anything to do except antibiotics and fluid and hope they were effective before her brain, in essence, dried up. She had bacterial meningitis. It was later found to be going around at her high school. She just happened to be one that it hit hard and fast. She was the only death from that outbreak that I heard about. Her mother and I talked a lot. She was my only patient as I had been called in to admit her. I was having a lot of difficulty with my daughter at the time. She was acting out, running away and pushing boundaries. At the moment she was a runaway. I did not know where she was. Her daughter was a good kid. Straight A’s, graduating from high school in a few months, planning on attending college, already had done her ACT and had been accepted. Was doing the beauty pageant to try and get a scholarship for college. The pageant she was participating in had a nice scholarship and she was hoping to place high enough to get most of her tuition paid. The father was dead. This woman had raised the three children alone, while two of them had blamed her for all of the bad things in their life. These two siblings were not around. When I asked her if she wanted me to try and call them, she told me about them. One was in prison. He had killed someone over a bad drug debt. He had stated he hated his family and refused any contact with them. He became angry and started using drugs after his father died. Her other daughter was in and out of drug rehab centers. Spent many months at a time in jail for drugs and prostitution. She was angry and wouldn’t speak to any family. Their anger was at the mother. The father had abused the children. When she found out she left him. Took the children. He committed suicide, afraid the truth about his abuse would come out now that she left. They never forgave her for leaving and “causing” him to kill himself. I remember watching this strong woman fighting internally to let this child die after it became apparent that she had lost the battle. She was basically alone and now childless. Losing parents is very sad, you lose your past. Who made you, who loved and influenced you, who made you strong. Losing a child, you lose the future.
Bam, thud, crack, now I am seeing anger, I want this to stop. I can see many many more rooms. All hospital rooms, all codes, death and sadness. Pain and loss. All of them I had witnessed and been a part of their last moments alive. I start crying out, the thud is now stinging. It feels like an open sore that is having acid thrown in to cause more pain. I hear the don’t move. I hear are you done? I hear “you remember your safeword don’t you”? I am crying, I am yelling, kicking and trying to form what I want, I am not sure of the safeword- am I? Am I not sure of it or do I not want to stop? I want the sensation to change, yes. But stop? I am not sure, I try to talk and am unable to. I sit up, not sure how I sat. Was I helped? Did I say anything? The images I have seen are flashing through my mind. I open my eyes, Tutivillus is handing me tissue. I remember asking for it, I think. I look up, I am starting to piece together where I am now. Back in the dungeon. Sitting next to Tutivillus. I want him to hold me, he touches me. He looks angry. He tells me he is not happy with me, I cannot do that to him. I have to remember my safeword. I remember my safeword. It is also a safe thing for me that I am there with him. I trust him to not go too far that I have permanent damage. We talk.
I am not sure why I couldn’t remember my safeword. Was I not done? Was I too deep? Was it something to do with the spontaneity of this type of scene that I didn’t prepare to stay in touch? I am not sure, but this journey was the same as others in the death and dying aspect, yet very different as to many of the scenes I saw were real life scenes I have participated in. Each of these were very short snippets of reminders. I lived them already, they didn’t need to be repeated. There were many more I could have seen. A cameo peek, like a fly on the wall watching me in each scenario. Maybe a while to think about these, maybe nothing more than the emotional losses in the past week of many patients dying. I will have to reflect and think about it.
