The Labyrinth Beckons - Part four

Continues...

We had almost lost Carolie and now confronted a bleak landscape of possible death or severe disability and brain damage.  We moved to a waiting room adjacent to the intensive care facility.  It was a subdued, impersonal space with soft chairs, computer facility and tea and coffee – the notion of waiting in a surreal transport hub returned, only this time we had some idea of the destination.   

An ICU nurse informed us of what was happening and how the ICU operated.  She was from the same ‘school of excellence’ that had produced the other intensive care nurses we encountered during that dreadful night and the many ahead.

Around 3am, Carolie was wheeled into the ICU.  We saw her soon after.  The machines had multiplied and she had lines emerging from many parts of her body, including two nose tubes and another emerging from the top of her skull that led to a bag mechanism that both captured bloodied fluid and monitored intra-cranial pressure (hereinafter ICP).  Others administered drugs intravenously via small dispensing machines that manage volumes and flows.  A rectangular ‘lunch box’ was dispensing a nutritious thick shake through her nose.  A saline water feed, doubling as an oral drug dispenser, came via another nose tube.  

Yet another tube channeled urine into a bag.   An arterial line emerged from her lower arm to monitor blood pressure.  She was on full life support.   The protocol in an ICU is one nurse per patient and these nurses are special.  They have obviously attained a high level of proficiency to qualify for this work.  As the name implies, it is intense.  Shifts are twelve hours long, with various short breaks and a ‘lunch’ break.  The lights are always burning, although it is possible to dim lights around patients during the night hours. 

Mesmerizing machines track patients’ vital signs – BP, pulse, ICP, breath dimensions, stimuli responses, cranial fluid drain rates and blood content, and a raft of other survival minutiae.  Integrated monitors like the one displayed on the banner of the blog became a looking glass.  I peered into them for hours together – they were both a window on Carolie’s inner workings and an outward signal of danger, distress, recovery and hope. It is difficult to convey the extraordinary impact these machines had on my consciousness and sub-consciousness.  Periods spent away from them were angst-ridden.  I only tore my eyes from them reluctantly while I was in the ICU.

ICUs are a twenty four hours operation with teams of allied professionals on duty at all times.  They have graded alarm protocols, calibrated to reflect the level of need and urgency. I will return to this later as they are pivotal to a patient’s survival in such life threatening circumstances.   

One of the Registrars on duty came up to me and said he knew my wife.  He was clearly a little shocked, as she had spent the morning settling his ‘kindy’ child into a new school year the previous Monday.  The first days at school for a little one are full of wonder and apprehension. It is another labyrinth of sorts and not always benign. Carolie has a rich history of guiding kids through the early years and on to graduation.  Many of her student cohorts reached out to Carolie during our journey.

Carolie spent less than 12 hours (the length of a nursing shift) in the Canberra Hospital ICU.  A helicopter was to transfer her to Royal Prince Alfred Hospital (hereinafter RPA) in Sydney, just over half a day since the first brain drain had been inserted.  Her time in this ICU was relatively uneventful, with her various pressures monitored closely, especially intra-cranial fluid pressure, as it is a critical indicator in SAH treatment regimes* - my obsession with the monitors increased.   

Apart from the occasional interaction between Carolie and a nurse, these ‘looking glasses’ were the only external signal of her metabolic processes at work.  Managed by computers linked to a centralized monitoring system, they have calibrated alarms that beep and wail according to the severity of the anomaly.  The slightest variations would get my immediate attention.  

Most alarms are just an alert that a particular drug has ceased or needs replacing, but if something is seriously amiss, ‘all hell breaks loose’.  On one occasion in Sydney, at a point deeper in the labyrinth, a junior nurse accidentally hit the ‘scramble’ button for a neighbouring patient, which set overhead lights flashing and a loud wail.  ICU staff came running from all directions to manage the crisis.  It was mortifying for the poor woman, shaken by her mistake, but for me it was a riveting demonstration of rapid response procedures in an emergency.  

I must have driven nurses to distraction at times with endless questions and curiosity but I needed to know how it all worked and what to worry about.  They answered all questions precisely with good humour.  Apprehension over a spike in numbers or indicator lines was usually pointless, but occasionally I spotted something a millisecond ahead of rostered staff.  This did not happen on the first night, as I did not know what to look for or to fear.  We were at the opening of the labyrinth; preparing for a dangerous, sloping tunnel with awkward twists.

Lou and I wandered off around 4am.  We went back to the school to pick up Carolie’s vehicle and made it home by 4.30am.  One of the worst nights of my life was winding down.  I tried to sleep, but was visited by night trolls and other terrors.  I kept reminding myself that it was not a bad dream, it was real and our lives had changed forever.  I kept calling out for Carolie, worrying our cat, who instinctively knew something was desperately wrong - why was I crying and railing after being out all night?  Cats notice subtle changes in their family environment and this was emotional tumult.  He was loving and comforting.   

At some point, I convinced myself to calm down and face the new day with some degree of fortitude.   My first email to one of Carolie’s closest friends was short and to the point:

          I have some sad news.  Carolie had a brain aneurysm last evening and is in a critical condition in the Canberra Hospital ICU.  It seems she will be transferred by air to Sydney for a procedure today.  The prognosis is not good as she experienced a lot of bleeding.  Life can be so cruel.

I had to let our son know.  He lived separately from us in shared student digs. I explained what had happened as best I could and that he had to be prepared that his mum would never be the same again.  At this stage, her chances of recovery were grim.  A young man in his early 20s, he coped remarkably well, with just an occasional bubbling up of raw emotion. It was going to be hard, whatever happened, and the signs were all bad.

The Labyrinth Beckons - Part three

Continues...

Confronted for the first time with life support procedures followed in emergencies, I expect most of us respond viscerally. Those hardened souls that manage their reactions dispassionately are obviously better suited to intensive care situations.  It is a shock for the unprepared and untrained eye, but daily fare for the highly trained, 'hard-wired' personnel that populate these units.  This was a dramatic initiation into the amazing arenas of critical and intensive care.  The lead players ooze detachment from the raw emotions and stressful responses of patients’ family and friends.  Machines take over, dispensing air and drugs, while monitoring blood pressure, pulse, brain activity and the complex dimensions of breath. 

Carolie’s next stop would be surgery to determine the nature and extent of the damage wrought by the aneurysmal bleed.  

After surgery she would be moved to an Intensive Care Unit (hereinafter ICU), where we could stay with her as long as we liked.  The mirror was melting and we were entering the labyrinth proper.   

Carolie’s eyes were closed and she was a terrible pallor, her blouse had been cut from her, lower clothes and jewellery removed, to be replaced with identity bracelet and a loose hospital gown; she appeared to be responding to commands such as “squeeze my hand”, “wiggle your toes”, “can you hear me”, but otherwise appeared out to it.  As I left the Resuscitation Unit, the nurse gave me Carolie’s watch and jewellery in a paper bag.  It was redolent with dire consequences. 

Waiting was again our lot.  Hours went by with no word.  We remained in the small waiting room, talking quietly, trying to keep anxiety at bay.   Eventually a member of the neurosurgical team appeared with an interim prognosis.  In a perfunctory manner - a trait I found typical of these accomplished brain plumbers – he informed us of SAH survival statistics (see previous post) and that Carolie’s prognosis was grim. She should have died from the bleed.  I heard this many times along the journey as a form of ‘encouragement’.   

Some medical professionals would do well as boot camp instructors – no room for cloying emotions in their world.  Aloof detachment seems a protective garb donned to project ‘professionalism’ and is perhaps honed to avoid psychological scarring from bearing witness to tragedy and grief;  the matter of fact, ‘cut to the chase’ style of delivery an antidote to the raw emotions that can well up from recipients of their advice. 

When a cerebral aneurysm ruptures, blood fills the space surrounding the brain.  CT scans* revealed she had bled across seventy per cent of her brain, which in usual circumstances could mean only thirty per cent brain functionality. Blood seepage into the brain is terrible as the body perceives the blood as a foreign invasion and launches an all out assault.  The brain becomes a veritable battlefield, which has devastating consequences for sensitive tissue. 

The surgeons inserted a cerebral fluid drain and started a further suite of drugs.  The surgeon explained there are two ways to staunch an aneurysm.  The first was the traditional method of a titanium clip inserted using a microscope after a craniotomy to expose the arterial bleed as illustrated below.  

The second and more recent method was termed ‘coiling’ and involved ‘endovascular image guided procedures’, placing a ‘coil’ in situ to stop the bleed, as seen in the next illustration.  

In the mid 90s,

          A revolutionary treatment was developed by Dr. Guglielmi, an Italian neuro-radiologist, where a fine tube is inserted from a needle puncture in the leg. This tube is navigated under advanced image guidance into the aneurysm and the sac delicately packed with very fine soft platinum wires shaped to look like coils that match the size of the aneurysm. Several such coils may be required to close an aneurysm; this basically depends on the size of the abnormal sac.+

The preference of the surgical team was coiling but this was not available in Canberra.  I gave my permission for a helicopter transfer the next day to Sydney.  The surgeon advised that Carolie was in post surgery recovery and would arrive in the ICU shortly.

To be continued...

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*              X-ray computed tomography, also computed tomography (CT scan) or computed axial tomography (CAT scan), is a medical imaging procedure that utilizes computer-processed X-rays to produce tomographic images or 'slices' of specific areas of the body.  CT scanning of the head is typically used to detect infarction, tumors, calcifications, haemorrhage and bone trauma.

+             http://www.irtreatment.org/procedures-and-treatments/brain-and-spinal-cord/coiling-aneurysmsah.html

The Labyrinth Beckons - Part two

Continues...

At this transition point you have not yet accessed the labyrinth formally - not knowing what to expect or what the system expects of you.  This changes once you are designated immediate family of an in-patient under intensive care. You suddenly belong!  Obviously you only have temporary status but it is an advance on the limbo of uncertainty.  Until that moment, it is like sitting in a waiting lounge of a large transport hub in a foreign land late at night, not knowing where you are going, whether you have a ticket or what the mode of transport might be, and whether your partner will join you in time.  The novelist William Boyd describes this unsettling phenomenon in his thriller, Ordinary Thunderstorms:  His appropriately named protagonist, Adam, enters a hospital ‘city’ in London:

          People wandered to and fro in this vast transit lounge – in transit from health to ill health – some, in dressing gowns, were clearly patients, others, in multi-zipped overalls in differing pastel shades, with name badges on their breasts and dangling ID photos hung around their necks, were orderlies or administrators of various kinds. There were also people like him in civilian clothes that must have been either visitors or else putative patients seeking entry in to this self-contained, health-city.  The mood was calm and unhurried – like an ante-room to heaven…Adam felt he was in some kind of human hive, a hive dominated by signs and acronyms:  everywhere there were signs, signs that made sense and others that didn’t;  signs that were welcoming and vaguely reassuring, others that provoked sudden dark fears - …signs that directed him to segments of buildings on this campus where every potential health need could be catered for – it seemed – in every functioning part of the human body and its glossary of maladies, from birth to death.*

I suspect these modern medical behemoths excite similar responses across the planet. 

Fear laced its way through all my emotions. The numbing effects of adrenaline and its cousin hormones wear off unfortunately, leaving you with the symptoms of hangover.  An extended crisis of the nervous system is a ‘big dipper’ on the metabolic front.  There are added dangers if you mix alcohol, sedatives and narcotics in the cocktail.  I was acutely aware of this and largely resisted the temptation over the journey, although I succumbed to the temptation of alcohol at times. 

The family of patients in acute emergencies are a curious phenomenon.  Like patients, everyone is different, and each is drawing on inner reserves to cope.  The middle-aged woman who shared the small waiting room with me had seen it all before. She was used to waiting while others resuscitated her child, who had a condition that resulted in occasional fits and seizures.  The mother was ‘chatty’, probably as a nervous reflex.  Whenever one of the nurses or doctors would come in, she would let off steam with a flurry of descriptions of previous events that led them here.  I tried to tune her out whilst my fevered brain struggled with various scenarios.   

 
Was it her heart?  Was it a stroke?  Would she regain consciousness?  Would she die?  It is a type of torture - the not knowing.  It suddenly dawned on me that I needed to contact Carolie’s sister, the only close family living in the same city.  Lou was shocked and left home immediately to join me in the gathering twilight.

On that first long night, only one other person knew what was happening and she remained a stalwart throughout.  Lou joined me in the waiting room.  I described the events of the evening, which was calming in an odd sort of way.  Downloading stressful events is helpful at times, but not if it has to be done repeatedly. I knew keeping all close ones informed of her condition and fluctuations in her prognosis would be a bridge too far, but they mainly kept their distance.  She became a conduit for family updates and this removed a burden. 

It seemed an eternity before a nurse came to usher us into the Resuscitation unit.  Carolie was sharing the space with another patient, presumably the daughter of the talkative woman in the waiting area.  It was a first inkling of what was to become our reality over the next months.  Gadgets and monitors surrounded her.  She had a breathing tube inserted in her throat and was receiving a blood transfusion.  

The nurse told us a burst brain aneurysm caused a massive loss of blood.  Carolie was receiving an analgesic and a hypnotic agent called Propofol, used in the ‘induction and maintenance of general anaesthesia and sedation for mechanically ventilated adults’.  Post-surgery they would start a drug called Nimodipine, a ‘dihydro-pyridine calcium channel blocker’ to reduce the likelihood of ‘vasospasm in patients with cerebral haemorrhage’.  

 The descriptor 'vasospasm' was to become alarmingly familiar. 'Vasospasm' refers to a condition in which a blood vessel spasm leads to 'vasoconstriction' (a narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels). This can lead to tissue 'ischemia' (a restriction in blood supply to tissues) and tissue death (necrosis). Cerebral vasospasm may arise in the context of SAH.  'Symptomatic vasospasm' or 'delayed cerebral ischemia' is a major contributor to post-operative stroke and death especially after aneurysmal subarachnoid haemorrhage.  I was to get a crash course in a medical lexicon and pharmacopoeia regime that was a fearsome yet ubiquitous backdrop to the labyrinthine journey.  

The few studies available on the subject of SAH tell us that the incidence of SAH in Australia is 8.1 (with rates for females being 9.7) per 100,000 people.  The mean age for an ‘aneurysmal’ event is 57 and 62% are female.  Understanding of the mechanisms that might trigger SAH is limited.  One study suggested that heavy physical activity might trigger SAH, but that there was no association between transient heavy smoking or binge drinking and risk of SAH.   Another found a possible protective role for hormone replacement therapy (HRT) on risk of SAH in postmenopausal women.  This finding really surprised me – I had associated HRT with a range of risk factors for menopausal women, which included my wife.#

My limited research into the subject of SAH confirmed little is known about causal factors and that the findings to date are not conclusive.  The fact that stands out is the incidence of SAH is not reducing.  My wife was 57 at the time of her SAH, was menopausal, did not smoke or binge drink and had not undertaken heavy physical activity.  

She had worked herself into the ground over years of dedication to her profession and had rheumatic fever and pneumonia during childhood. Possibly these latter events had weakened her arterial wall in places such as the brain, and cumulative stress and tiredness did the rest.  Who knows?  We now confronted a 9.7 in 100,000 event, about which even experts know very little.

If you are inclined toward the rational and spend your life in awe of medical knowledge, I suggest the paucity of understanding of this condition will leave you worried and disillusioned.  If you are drawn intuitively to notions surrounding non-rational archetypes, any illness can take on symbolic import.  Tacey asserts the latter response is conducive to deeper healing in the event of life-threatening disease:

          When you stop cursing the symptoms and get deeper into the images instead, the healing comes.  But the healing never starts at the place of the symptom…First you have to be healed in your soul.  The paradox is that the wound, the illness, is also the treasure.  The physical misery gets your attention.  But then if you go deeper into it, there is much more to it, memories and imagination and worries that will come.  That’s where the treasure is, in the psychic images that come with the symptoms.  The symptoms open you up.  They literally tear you open so that the things you need can flow in.+

I can see the importance of understanding symptoms beyond the rational exposition provided by medical science, especially when the exposition is largely limited to manifest symptoms, and lacking real awareness of causative factors at work.  My rational mind wanted to comprehend what had happened and what was happening to intervene; my intuitive mind grappled with the spiritual reality at play.  As a profoundly spiritual person, I knew Carolie would share my interest in a deeper understanding.

To be continued...

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*              William Boyd, Ordinary Thunderstorms, Bloomsbury, 2009, pp.56-57

#            See “Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand:     incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS)”, http://www.ncbi.nlm.nih.gov/pubmed/10926945

+             Albert Kreinheder, Body and Soul: The Other Side of Illness, cited in Tacey, op. cit., p.47

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(II) The Labyrinth Beckons - Part one

  

We arrived at the Canberra Hospital (hereinafter TCH) Accident and Emergency department around 10pm.  Carolie went directly to a ‘recovery and resuscitation’ unit, while I went to an adjacent family room, occupied by someone waiting news like me.  I had no idea what to expect.  For me the ‘emergency’ environment was a twilight zone.   

Large hospitals are akin to a labyrinth in many respects.  Endless well-lit corridors all look the same; in some areas, coloured lines painted on the floor lead off in many directions; signs with arrows bear no resemblance to your sense of the space; employees in similar garb wander the corridors with clear intent but little concern for your spatial befuddlement.  My heightened sensory awareness added to the ‘Alice reaching the bottom of a very deep well’ effect.

The two large public teaching hospitals we encountered in different cities evoked a sense of enclosure in a single labyrinthine abode, operating outside constraints of time and place.  Night and day are almost indistinguishable in emergency and intensive care spaces.  Discernible shifts in work rhythms and light intensities are the only indicators I noticed.  People come and go constantly without much notice.  An occasional interpolator acknowledges your existence briefly, moving quickly on to another engagement.   

After a while, you feel almost invisible, an observer in a large fish tank full of permanent players circling  relentlessly, in a continuous interplay with visitors who dart about anxiously or settle nervously, waiting for cues from the ‘players’.   As I later explored this environment I came upon dead ends after dutifully following signs; stairwells beckoned to nowhere; cavernous lifts would move up and down between floors that had few distinguishing features.  The easily distracted could find themselves searching for units, wards and rooms on the wrong floor. Alice again:

          There were doors all round the hall, but they were all locked;  and when Alice had been all the way down one side and up the other, trying every door, she walked sadly down the middle, wondering how she was ever to get out again.*

Long corridors with tributaries and large swing doors at regular intervals hide undiscovered territories through which only initiates may pass. New building developments merge with old stock in a strange conglomerate of differing materials and discordant spatial designs. This phenomenon was a pervasive element of the journey. 

Labyrinths can be transformative spaces, and have long held such a place in tales of magic quests and mythical lands.  They can also be forbidding and scary with nasty surprises lurking in corners.  They pop up in the lexicon of holistic healing, but sadly, ‘healing labyrinths’ are a phenomenon largely ignored by the scientific paradigm. 

Someone in circumstances like mine is under extreme duress; not knowing the fate of their beloved; unfamiliar with the space, procedures and the personnel involved.  You feel dislocated; everything is uncertain and no one has yet put your mind at ease.  It is otherworldly in many ways. 

To be continued.......

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*              Carroll, op. cit., p. 6

The Rabbit hole opens - Part two

Continues...

Two paramedics treated Carolie immediately on arrival.  One of them came to tell me she had experienced a seizure but was still alive.  I was still prevented from seeing her, which is an understandable protocol given the automatic tendency to rush to a loved one.  I would have been in the way.  The paramedics organized breathing assistance and brought her out on an ambulance trolley. 

She was a pallid colour and appeared barely alive.  I held her hand as they put her into the ambulance.  She managed to say something – I think it was “Grade 5”.  My guess is the last thing she was doing was a roster or a schedule connected with that grade.  She was found near the staff photocopier.  Something as prosaic as a class roster was the last thing on her mind as she slipped into a bewildering dimension of continuous light, beeping machines and prodding hands. 

Intensive care professionals have told me that every minute lost in treatment of a brain bleed is crucial to the outcome - a matter of life and death and a possible determinant of extent of brain damage.  I estimate it took the police well over an hour to enable paramedics to start treatment. Possibly their default reaction to an anxious person claiming their wife is on the floor behind a locked door is studied scepticism.  They certainly took little heed of my obvious anxiety. 

Had the police reacted immediately and forced entry, her treatment would have started within 15 minutes.  Clearly the emergency was only obvious to me.  What does this tell us about ‘standard operating procedures’ in these circumstances?  Why not force entry to the building?  Why was an ambulance not rung until Carolie was found?  Why did they ignore my pleas? I am haunted by my failure to convey the gravity of the situation.  My warnings were treated as something else. 

I recall one of the constables coming up to me just before I left to follow the ambulance.  He said, “Sorry”.  I do not know whether he was sorry about their general tardiness or just sorry for us in the circumstances.  Probably the latter but it has stuck with me.  

As a postscript, one of the attending police rang me a couple of weeks later, when Carolie was in the Neurological Intensive Care Unit in Sydney.  He informed me as part of a “duty of care” he was following up what had happened and how we were.  The irony was not lost on me and I did not let him down gently, letting him know that I would be following up my concerns with Police management - I might just encourage them to read this.

On leaving the school, I trailed the ambulance through the wet Canberra night.  Everything was eerily still.  The city is easy to move around after business hours, as the roads are wide and relatively empty.  They did not hurry or put their lights on.  I wondered about that but I imagine there were practical operational reasons. 

My mind was in a fever.  What had happened?  How bad was it?  Would she live?  The awful surrealism had intensified – acute fear had subsided, replaced by a creeping, almost detached, dread.  Everything was in slow motion, colours and sounds intensified; I was mindful of my thought processes – observing my reactions to the situation distractedly from a distance as if in a cinema. A rabbit hole had opened and we were tumbling downwards together in the dark.  Carroll captures it brilliantly:

          Either the well was very deep, or she fell very slowly, for she had plenty of time as she went down to look about her, and to wonder what was going to happen next.  First, she tried to look down and make out what she was coming to, but it was too dark to see anything; then she looked at the sides of the well, and noticed that they were filled with cupboards and book-shelves:  here and there she saw maps and pictures hung upon pegs.*

It was that sense of everything reduced to slow motion in response to acute shock.  Violent energy appears to be funneled through a transducer that projects a three dimensional cinematic event in slow motion.  I had experienced something similar in a car accident, where I became an observer of, rather than a participant in, the extreme action.  One can write a poem, have a smoke, and take a coffee, whilst action taking split seconds hurtles around you. The ‘bubble’ is calming in a weird way.  

I do not know the exact metabolic processes at work in such situations, but it provides a protective sheet under duress, and doubtless involves adrenalin triggering other built-in hormones and neurotransmitters - an innate coping mechanism.  Jefferson Airplane¥ was spot on - Alice was off her head via in-built neurotransmitters:

          ‘Dear, dear!  How queer everything is today!  And yesterday things went on just as usual.  I wonder if I’ve been changed in the night?  Let me think:  was I the same when I got up this morning?  I almost think I can remember feeling a little different.  But if I’m not the same, the next question is, Who in the world am I?  Ah, that’s the great puzzle!’*

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*              Lewis Carroll, Alice’s Adventures in Wonderland, The Folio Society, London, 1961, p.4

¥             Jefferson Airplane, “White Rabbit”, 1967

*              Carroll, op. cit, p13

(I) The Rabbit Hole Opens - Part one

On that fateful night in 2012, Carolie was working late and alone, sorting timetables, rosters and the minutiae of a school in its first week back from the summer break.  I rang her at 6.45pm to request she collect some items for the evening meal.  I did not really need them but it was a well-used ploy to get her to come home.  She is very absorbed in her work, which is for many in this role a ‘calling’ rather than a job.  Working late and most weekends was part of her existence and something around which I had to strategize.

A sudden jolt in the daily round reveals we muddle on under a chimera of safeness.  The familiar anaesthetises against fear and terror; expected patterns and rhythms set up an illusion of what is ‘normal’.  To cope with the unknown and the 'unknowable' people often turn to faith and belief, trusting in divine entities or the wonders revealed in nature.  Some draw strength from spiritual faith in existential mysteries of the ‘here and now’ or the building blocks of our perceived reality; others take solace in belief in a divine ‘otherness’ and an ‘after life’. 

Discernible truths on how to navigate life’s mysteries emerge from ancient wisdom, spiritual practice and human endeavour.  Atheists and religious believers alike value selfless love, often expressed through service and sacrifice; they see nature’s wonders as evidence of the connectivity of all things, determined by a divine being or whole unto itself.   

What little grip I had on the fundamentals of existence came into stark relief that night.  Real faith and belief are profound touchstones for many.  For me the matter is simple – we cannot begin to grasp the unfathomable with rational cognitive tools; the intuitive or transcendental mind takes over:

         

Mysticism keeps men sane.  As long as you have mystery you have health; when you destroy mystery you create morbidity.  The ordinary man has always been sane because the ordinary man has always been a mystic.  He has permitted the twilight.  He has always had one foot in earth and the other in fairyland.  He has always left himself free to doubt his gods; but (unlike the agnostic of today) free also to believe in them.  He has always cared more for truth than for consistency.*

The Tao Teh Ching of Lao Tsze+ opens:

                    The way to which mankind may hold

                                    Is not the eternal way.

                        Eternal truths cannot be told

                                    In what men write or say.

You may rely on finger-posts to eternal truths - profound words, paintings, music, great discoveries and wonders of the cosmos.  From these you can fashion a spiritual toolbox, a lexicon of belief, a trust in deeper meanings, or just a hope for the best.  You may fear the prospect of serious illness, an accident, a sudden event you have no control over.  When it comes to the crunch, what do you do?  Will you have inner fortitude or cry out for help from an unknowable ‘other’, whether it reside in faith or intuition, within or without?  How do you cope with catastrophe?  It is an existential conundrum and I was far from sure I would cope in a crisis. There is a great line - “We’re in control until we’re not!”  This was one of those moments in spades.

Over my life, I have dabbled in several areas of ‘spiritual’ practice.  Since my teen years, I have been prone to depression, which goes some way to explaining an interest in ideas and activities to balance body and soul.  The ‘black dog’ has toyed with me regularly. Episodes at boarding school and in various higher education and work places triggered emotional turmoil that led to clinical depression. As a survival tool, I masked it with an outward demeanour of disengagement or indifference, while raging within.   

The notion that ‘spirit’ resides within all things – matter imbued with mysterious forces that influence our lives – resonates profoundly with me.  Growing up in Melanesia, and a later exposure to metaphysical ideas emanating from various philosophies and quantum physics, reinforced an intuitive sense that subtle forces are at play in all matter.  These forces are typically symbolised by non-rational archetypes – gods, prophets, saints and spirit totems - at the centre of animistic belief systems and the mysticism of religious philosophies.  

 An early interest in Tibetan Buddhism garnered a limited knowledge of meditation and the use of mantras, short prayers chanted to open the intuitive mind to subtle knowledge.  I have chanted a short mantra all my adult life to ease the anxieties of the daily round.  It has been a great comfort at times of stress and much employed in recent times.  I took up hatha yoga as a young man living and studying in India and have instructed others off and on for over thirty years.  Through this practice, I learnt something about the interconnectedness of body and mind, of emotional intelligence and physical well-being.   The events described here beckoned the ‘dark beast’ many times, and sorely tested my capacity to keep it at bay.

Getting back to the tale, my crunch came on a wet night as a typical unease with my wife’s lateness grew.  I knew she was prone to diversions and tangents and could easily field a phone call or an email that would make time stand still.  However, our local shops close at 8.30pm and she would unlikely ignore my request completely.  By 8.40pm, when she had not returned, I was ‘alert and alarmed’ to use a much-misused phrase in the modern security lexicon.  My first thought was a car accident in inclement conditions.  

 I jumped in our car and proceeded on Carolie's route to and from school every day.  My agitation was rising but had not hit panic mode. The intuitive mind appears to set off chemical triggers in the brain that readies you for something fearful; it had me on full throttle. On arrival at the school, her car was in its normal place.  I felt a sickening dread wash over me.  It is curious that a situation so superficially normal can be so discordant when it occurs outside ‘normal’ time and sequence.

My jolt was now a full-blown horror.  A locked school door and Carolie not answering her phone - something was drastically wrong. My mobile battery was low. I rang her several more times and then triple ‘0’, explaining the situation to the operator.  The closed door left me uncertain whether to ask for an ambulance or the police.  She advised the police were the best to respond as they could call an ambulance.  

The waiting seemed an eternity.  I fought the urge to use a tyre brace to break a glass panel on the door and enter.   You are tempted to burst the bounds of conformity - should I break the law or hold my nerve?  Could a failure to act be life threatening?  It was an angst ridden ten minutes until a police van arrived. 

Unhurriedly, three constables strolled over and inquired what the problem was.  I explained the situation yet again.  I made it very clear that this was most likely a medical emergency.  They proceeded to look around the school in a leisurely manner to see if they could sight Carolie, despite my plea for an ambulance. After a perusal, one of the constables told me she was not in her office.  He then suggested she might have gone for a walk. I really wanted to shake this constable.  It had been raining heavily. I replied that Carolie would either be on the floor of her office or the staffing room.  I wanted to shock these young men out of their apparent somnambulism but words escaped me: Why were they not breaking the door? Why were they so stupid? 

My emotions were at fever pitch but I knew it was useless trying to interfere. What do you do when you are at the mercy of authorities that have no sense of the alarm you are experiencing, no sense of the crisis unfolding behind the closed door?  My inner voice was shouting.  Waiting for that bloody door to open was surreal in its awfulness and aged me several years. I could not know this was just a curtain raiser to the panoply to follow, all of which was way outside my comfort zone. 

The police contingent eventually decided to ring school security - it would take twenty minutes for the night duty officer to arrive.  I was apoplectic but maintaining a semblance of worried calm. A second van of police came during the wait, which did not sharpen the decision-making. To this day, I have no idea why so many police came to the school.  It occurred to me that perhaps they suspected me of something.  

 It took all my self-control not to scream at them, which would have probably led to my arrest.  When security arrived, the police accessed the building.  They found Carolie immediately in the staff room unconscious on the floor.  I was told to stay at the door - a constable monitored me to ensure I did not enter.  It was only on finding her that police called an ambulance, which arrived within 15 minutes.  

......to be continued

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*                    David Tacey, Gods and Diseases, Harper Collins Publishers, 2011, p.16

+                  Tao A rendering into English verse of the Tao The Ching of Lao Tsze, Translation by Charles A Mackintosh, The Theosophical Publishing House, 1926