Long Day's Journey - Part six

A mere ten days after the craniotomy ‘Mr Sensitive’ - the junior registrar from neurosurgery - arrived with more bad news.  Since the scare of the cardiac arrest, the head neurosurgeon had been scouring pictures from the angiogram series.  He noticed something that suggested the bleed had not stopped, which would explain the sudden spike in ICP five days ago.   

The clip had not done the job.  A larger clip in a slightly different position would staunch the bleed completely. The relative risks of action and inaction were clear and on we must go. Feeling desolate, I gave my permission yet again for the procedure. Carolie had to go under the knife again, two weeks after ‘successful’ surgery.  

The surgeons had ceased ‘Thio’ many days back but Carolie remained in deep coma.  As I predicted, the drug was slow to leave her system.  My hope was that she had pulled the shutters down for a deep healing sleep.  The gloom threatened to settle around us.  I could not bring myself to inform anyone, except an occasional phone call.  

 I tried to take a day off from the ICU but felt so guilty I returned during the night.  The normal diversions such as exercise, a bit of retail therapy, time spent chatting with friends had lost their allure. Days merged with nights.  I stayed longer by Carolie’s side, terrified she might slip away if I was not with her.  I imagined the worst when I was absent.  Time spent out of the hospital was harrowing so I tried to limit it to hours needed to eat and sleep. 

These were the dog days of the recovery vigil.  Worry gnawed away while I clung to hope like a life raft in dangerous waters.  The passing cavalcade of doctors, nurses and attendants became a blur.  I talked to Carolie constantly, holding her hand, massaging areas not wired up to manage her treatment, pleading with her to come back to us.   

The support monitors beeped like pinball machines and the wavy lines were outward proof of life.  Apart from regular turning to avoid pressure sores and adjustments to lower limb devices and positioning to avoid thrombosis, all else was still.   

Nurses’ routines of checking eyes with a torch, clearing the breathing tube, swabbing the face and issuing verbal commands to squeeze hands and move toes were all that broke the monotony of waiting.  

I had a strong sense of us searching for each other in a dimly lit corner of the labyrinth.

Long Day's Journey - Part five

Close quartering with intensive care operations provides uncomfortable insights. Your cloak of ‘invisibility’ enables close observation. On one occasion police appeared at the nurses’ station. My radar told me something was amiss with the latest arrival next to us. Snatches of conversation came drifting across to me.


The man in his 40s had extensive brain injuries. He had been alone and unconscious for many hours. Pronounced ‘brain dead’ on arrival, it seemed he had been the victim of some form of misadventure, warranting a coronial inquiry. Various male relatives or friends arrived during the late afternoon to hear the bad news and pay their last respects. At some point, his closest kin gave permission to turn life support off and that was that. He was gone. During the course of an afternoon, a drama played out in the streets of our largest city ended in a man’s death in the next bed.


In a lighter vein, one of the senior registrars was a ‘fang merchant’. I rarely saw her without a consumable. On arrival, she would eat and drink, heading off in the direction of in-house eateries at every opportunity. She snacked relentlessly, between wandering the unit like an authoritative behemoth, issuing instructions and declarations in all directions. This emissary of the “Red Queen” never acknowledged my existence, which was a blessed relief. I mused on a snippet of Carroll’s rhetorical nonsense that fitted the scene:


‘A slow sort of country!’ said the Queen. ‘Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that.’


We were running standing still, and not getting anywhere fast. I marvelled at the studied patience and quiescence of experienced nurses in the face of such wanton displays of hubris and self-importance. It was humbling to witness their discipline under fire, especially toward the end of a demanding shift.

The amazing nurse cohort came from all over the world. There was a ‘jordy’ from the north of England, Irish and Scots. I met an African, a Norwegian and a Canadian amongst the group. Asian nurses – from the Philippines, Thailand, India, Sri Lanka and China – were in a majority. While Nurse Managers and many of the senior ICU nurses were mostly native born there was a preponderance of registrars from Sri Lanka and India, countries where there is, ironically, a culturally based obsequiousness to status and authority.



Drives to recruit foreign nursing and medical staff on short stay visas have clearly plugged personnel gaps in areas of the labyrinth. Nevertheless, what does it say about long-term human resource planning in this essential service area? State and Federal Governments have served us poorly over decades.



A highlight of ICU days was the rousing support of family and friends. It is impossible to put too much emphasis on their role in getting me through. Large labyrinths are bewildering and hide their inner workings, but they can conjure a strange healing alchemy between people. The occasional kind native provides fleeting engagement and solace, but it is difficult to shake the sense of being an outsider in an industrial space with the warmth and charm of a dressed up dystopia. Yet, a veritable magic enlivened shared experiences with people close to me.







It was hard for visiting friends. Confronted with a comatose Carolie, swollen beyond recognition, their shock was writ large. Many poor souls do not survive their journey in the labyrinth. A lot needs to go right and close support from others is an amazing fillip for patients and family. In our case, lapsed friendships suddenly came back to life; distant friends sent healing thoughts. Visits from close family and friends helped me take stock of thoughts and emotions, which ran unchecked most of the time.






Our son visited spasmodically as he was settling into a new life as an acting student and share tenant in Sydney. He coped with the ‘coma’ phase rather well, sometimes helping to calm his anxious father. His years of working in a pharmacy had left him sanguine about the application of the hospital pharmacopoeia.


Some friends visited when I was not at the bedside and these provided a different succour; it comforted me to know someone was on vigil when I stood down for personal maintenance. They were there for her and that mattered a lot in the scheme of things. An occasional quiet lunch or dinner with family and people who knew me well was therapeutic in that I could download some of the angst and try to talk about something else for an hour or so.

A reiki practitioner focussed her healing technique from afar. My yoga class in Canberra channeled healing messages. School kids sent messages of love and healing wishes. We were going to need all their love and support.


To be continued...

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*              Lewis Carroll, Through the Looking-Glass, The Folio Society, London, 1962, p.27

Long Day's Journey - Part four

Continues...

The different cohorts you encounter shape the cultural landscape of the labyrinth.  Top of the food chain are various specialists, whether surgeons, anaesthetists, consultants or senior registrars.  My interactions with this class were spasmodic and cursory.  Obviously, they are all short of time. 

The senior neurosurgeons engaged me on occasion, usually when there was a substantial development to report or procedure to implement. They kept discussions to a minimum.  A junior registrar was the designated ‘gofer’, sent to fetch permissions, update the situation and convey bad tidings. He was prone to the declarative gestures common amongst his tribe.   

One ‘clanger’ was a rather casual observation that a previous assessment that Carolie would likely resume a normal life was now qualified and that she would never be the same again.  This came without clinical context or any ‘parenthetical amplification’ to assuage the nasty effect it had on me.  He was a regular visitor to the ICU as neurosurgeons are central players in this area. I later suggested his choice of words were insensitive at times.  He replied arrogantly that this was his way and that it was best to lay out the ‘facts’.  It was a tad depressing to think he inculcated such communication strategies as part of his training.  

I wondered whether a focus on emotional intelligence might better prepare medical specialists to deal with people meaningfully. Nurses did their best to mitigate the worst effects of the medical hierarchy’s studied disengagement.

I perceived a lack of either empathy for or genuine interest in the fate of individual patients emanating from the senior medical cohort.  Doubtless this is woven into their DNA via training and operational culture.  Obviously, there are too many damaged souls and they maintain a detached professionalism to be most effective.  I would argue that a more personalized approach is preferred, whilst retaining professional objectivity.   

Across the public sector it is a truism that the more senior staff become, the less contact they have with actual ‘people’.  Those who determine policy and the quality of service delivery become increasingly detached from the supposed beneficiaries of these same policies and services.  Clearly, the senior medical cohort do have contact with patients and family, especially when they are directly involved in their treatment.  From my personal experience, a surgeon who treated me in recent years visited me every night after my procedure and spent ‘quality’ time with me.  I wondered whether he ever saw his family.  

During our stay a member of the senior cohort wandered into the ICU occasionally to engage the shift registrars.  They were obviously clever and skilled and wore their status like a cloak of unapproachable authority.  I was reminded of a kind of aristocratic mannerism I have experienced in England – personable, chatty, but a body language resonant with detached superiority and an implied declaration – ‘do it my way or the highway’.   

It must be difficult for the senior cohort to avoid falling into absolutism in managing junior cohorts, especially if they have trained under authoritarian regimes. Someone has to be in charge and make decisions.  Yet, collegiate processes are healthy, and respect for leadership should derive from performance, knowledge and skill.  ‘Best practice’ must surely be a touchstone in a teaching hospital, and doubtless guides the work of the labyrinth, despite its evident spatial, operational and cultural limitations.

One of the senior ICU registrars made efforts in my direction.  He would put on his ‘concerned’ face and sit with me.  Whenever he finished his expositions, I would steel myself for Carolie’s imminent demise.  On occasion I was so upset by his words I sought further clarification from nurse managers.  They would explain that he was outlining broad parameters that would not necessarily apply to Carolie.  He would wander off, pleased with his handiwork.  He reminded me of a central character in the Discworld novels of Terry Pratchett.  A central character - ‘Death’ - never enjoys his work – he has a hangdog approach to the harvesting of ready souls. 

None of the registrar’s dire prognostications took place.  I recall him arguing the toss with an ICU consultant as to who should remove Carolie’s brain drain.  He was adamant it did not fall within his responsibilities and should be the domain of neurosurgeons.  One of the experienced ICU nurses later removed it in a blink.

Social workers are a discernible ‘tribe’.  When you arrive in an ICU or high dependency ward, they are quick to make their presence felt.  I was ushered into a deep and meaningful meeting with an earnest soul, and regaled with a shopping list of potential support opportunities; a veritable smorgasbord of help.  The parking pass was one of them.   

Another was a list of local accommodation with reduced tariffs for family visiting the hospital.  There were others on offer but it was little more than a check-list exercise.  I quickly discovered the pass was a cruel illusion.  The accommodation prices turned out to be wrong as Sydney hotels were cashing in on the Gay Mardi Gras by hiking all their tariffs.  To access a petrol subsidy required a process bordering on the absurd.  It would have cost more than the pitiful reimbursement.   

All of the social workers met on our path were engaging, likeable people operating in a bureaucratic maze of ticked boxes, regulations and illusory support.  They coordinate in-house meetings designed to provide information feedback, and facilitate form filling by in-house actors, and they know a thing or two about off-campus parking.  All seemed run off their feet, dashing from one meeting to the next, providing gratuitous advice, getting the check-lists and meeting minutes sorted.      

To be continued...

Long Day's Journey - Part three

Continues...

Once into the ICU area I ran another gauntlet – the receptionist.  Over weeks, most would let me in on suspicion that I was not masquerading as someone else.  That was a comfort.  Yet, one took delight in putting me through the hoops.  I suspect he was a retiree from one of our disciplined forces.  He had a determined look that suggested any expectation of sympathy was fruitless.  This was his domain and no anxiety-riven family member was getting past him without clearance from the shift nurse, no matter how many times I confirmed my relationship to a comatose patient.  

 Every so often, the word from the unit was to stay outside until doctors did their rounds or nurses attended to Carolie’s ablutions.  I would sit for hours, witnessing all manner of things done to her, but the occasional intervention was strangely out of bounds.  There was no obvious logic to these random exclusions, especially since they knew I was her next of kin and likely prime carer. 

I particularly failed to grasp why morning rounds were sometimes an exclusion zone.  For me, these mini seminars were a moment of clarity as the ranking ICU registrar or consulting specialist oversaw a coordinated update on each patient’s situation and prognosis, in the company of shift nurses, interns, residents and registrars.  

 In a teaching hospital, morning rounds provide trainee staff opportunities to demonstrate and build on their learning.  When not excluded completely, I found the dynamics and substance of these daily seminars instructive.  Although the artificial walls of bed screens would often exclude me, I could hover at the central station and overhear proceedings.

Senior registrars or consultants would turn up intermittently with students or an intern.  Inured to any effect these exercises might have on family, various scenarios and prognostications played out between mentor and trainee as if they were in a soundproof booth.  These were exclusive exercises for self-absorbed initiates. Carolie was an abstraction, an ‘interesting case’.  I heard every word and nothing brought comfort.  

I wondered at the complete lack of concern that the patient or family might be hearing these dire prognostications and losing hope.  In fact, he was asking his student to hypothesize on the basis of ‘knowns and unknowns'.  Her actual circumstances were beside the point.   

In recent years medical communities in some countries have focused on health design, environment, and patient-centered care; in recognition that subjective and amorphous qualities, including attitude, state of mind, and personal empowerment, can have an enormous impact on a patient's treatment and recovery.  I saw some evidence of this evolving regime in the practices of ICU nurses and a few medical staff, but Australia has a long way to travel if equal emphasis is to be given to inner and outer healing. 

The relative willingness of key players to enlighten, listen and respond to real concerns and fears was instructive as an indicator of progress.   The majority of nurses and an advanced trainee specialist in intensive care provided glimpses of how an integrated model might work with doctors and nurses working together closely at its hub.   

Rather than operate on the periphery - a ‘high-wire exponent’ called on only as required - the trainee was hands-on from the outset.  His explanations of Carolie’s treatments were regular, informative, detailed and constructive, avoiding the pre-determined prognostications of others we encountered.  He dealt solely with actual specificities, rather than generalized declarations, and kept me abreast of updates generated from CT scans, angiograms, X-rays, pathology tests and any associated revisions to the treatment regime.  It was refreshing, comforting and most of all, empowering, to have quality feedback and a manifestly genuine interest in our plight.  I was more relaxed when he was on shift and missed his input terribly when he moved on.

From our overall experience, Australia has a way to travel to be at the leading edge of integrated care. Courses abound and there is an emphasis on skills development, but the labyrinth only showed glimmers of interest in holistic healing approaches.   

Rather, the medical establishment seemed inclined to pull up the drawbridge and repel boarders. 

A medical culture steeped in highly structured, rigid work practices, with truncated dialogue between in-house cohorts, patients, family, carers and other stakeholders, will be slow to change.  Yet, a better paradigm might be on the horizon. Following is the mission statement of the “life house” under construction for cancer care:

The facility will integrate clinical care, research, education and integrative therapies, creating opportunities for innovative discoveries, compassionate holistic care and better outcomes for patients, their families and carers.

This could be a healing space if the promise is more than just a glossy ‘promo’.  Positive indicators from our own journey left me with hope that certain redundant practices might evolve in time. 

Thoughts of how to manage life-threatening illness come into stark relief when patients in danger surround you.  The spatial disharmony of the ICUs – the ‘fractured mosaic’ referred to earlier - was hardly ideal.   

 

I kept imagining the characteristics of an effective healing space, where teams of allied professionals and complementary therapists worked together in an integrated way, technically and spatially, with patients at the centre.  It would curtail the endless traipsing off to other areas for various procedures, physical disruptions that must inevitably disturb, and occasionally threaten, recovery processes.  Removal from and return to the controlled environment of the ICU was a constant for Carolie throughout her stay.    

The traditional hospital design of intersecting linear corridors on multiple floors is counter-intuitive to service integration and management.  The old layered box construct, typical of 19th and 20th century administrative systems, is not conducive to an enlightened approach to hospital management, as described above. Architecture informed by an integrated philosophy of healing would see a different paradigm emerge. The labyrinth would get a makeover, spatially and culturally.

 To be continued....

Long Day's Journey - Part two

Continues....

Each morning I tried to shorten the time of the journey to the hospital but the city was in the way.  I was out of touch with the traffic rhythms of a big city.  If I left before 7am, I could make it within a half-hour; any later and the time blew out exponentially.   

I patronized a local cafe for breakfast.  One of the waiters got to know me and I shared with him some of Carolie’s situation.  He was a Pakistani migrant who, in keeping with many such encounters in a lifetime of travels to the Indian sub-continent, was kind and engaging.  His chats were therapeutic in a way as they took my mind off the ICU.  We exchanged tales of travel and coming to grips with alien shores.  I had been a postgraduate student in India for over four years in the late 70s and early 80s, and he had migrated to Australia several years back.  A shared experience of voluntary displacement is an easy basis to strike up a rapport.  I appreciated a charming man who went out of his way for a bruised soul.

I became a regular at a few establishments, as the familiar is a solace at times of dislocation.  Both luncheon and dinner venues had staff that came to recognize me.  My demeanour was probably grave as the news most days was grim.   There were no indications Carolie was waking from coma and her vital signs were not stabilizing.  Her oedema was alarming and the blood content of her brain fluid remained high.   

There was nothing to lift spirits but the people I met in these small cafes and restaurants were kind and understanding.  I suppose it comes with the territory if you run an eating establishment in the vicinity of a large hospital – some customers are bound to be in the midst of crisis.

The approach to RPA from the suburb of Newtown takes you past one of the old residential colleges of Sydney University.  Just past the college is the side entrance to RPA - 500 metres as the crow flies from where Carolie and I first met in the early 70s, at one of the other colleges in the university precinct.   

The front entrance to the main building is a little further on.  To reach the ICU visitors pass through the main vestibule to the back of the building or take a side road past the cancer centre to a roundabout at the back.  Taking either path, the blend of new and old building stock hit me in the eye 

Victorian Gothic designs with tiled floors and stained glass give way to layers of industrial glass and steel; interconnected sandstone vestibules bring you to a transparent facade, ceiling and stairwell through which an Escher-like staircase straddles many floors.  You emerge from heavy stone architecture to a space filled with light, fluid textures and tangential lines. You can reach many parts of the building via the ‘crazy’ staircase or by lifts to higher floors.  However, the grandiloquent glass gesture to modernity quickly gives way to predictable painted and tiled corridors; each floor looking much the same.  

The ICU is on the lower ground floor, along with various outpatient units.  The approach to the back entrance runs a dismal gauntlet of smokers, thrown together in their desperate need for nicotine.  Wheelchair-bound patients with feed drips by their side puffed away.  One steered his wheelchair backwards, using his feet to get to a smoke. Some were ‘escapees’ from ICUs; acute illness had not come between them and a cigarette.  

I recognized one of the smokers from Carolie’s ICU. He moved back and forth between one of the neurological wards and the ICU – recovering from an aneurysm did not get in the way of his need to smoke.  When nurses put their foot down, he would carry on until they relented.  

 This was startling proof of the old adage that nicotine addiction is harder to beat than heroin.  Many hospital workers join the smoker’s throng, a desperate absurdity given their proximity to lives curtailed by smoking.  It is a terrible addiction.

To be continued....

(V) Long Day’s Journey - Part one

I settled in for the long haul.  Coming to grips with the landscape was part of surviving the labyrinth - its spatial eccentricities; the frequently obtuse utility of support services and the sanctuary of surrounding oases – coffee shops and restaurants.  In the beginning, I struggled with directions; fell into ‘in-house’ watering holes out of desperation; avoided the nearby street-scape that was noisy, crowded and uninviting.  

 Dispersed behind large hospital buildings I discovered vacant areas that serve as paid parking lots.  It felt like a dystopian wasteland, bound on the edges by huge buildings awaiting demolition.  Dark and forbidding, these remnant gargantuan entities became redundant over time - probably riven with asbestos and the detritus of superseded technology – and now stand guard around this veritable no-man’s land.  Vacant building lots behind massive hoarding boards projected utopian images of a new ‘lifehouse’ – a promised land of innovative caring opportunities.*  I wished the so-called life-house was available right then.  I later discovered it would be a cancer care facility.

 A multi-storey car park straddled one of the remnant spaces from a bygone era.  It was restricted to staff and a select few visitors lucky enough to obtain a pass.  Early on, I was advised by a helpful social worker that as an out-of-town visitor living a sufficient distance from Sydney I was eligible for a parking pass.   

A form was duly completed and submitted to an office occupied by one person – the ‘gatekeeper’ of parking.  She obligingly took my form, advised there were no passes available and suggested I ring back later in the day to check.  I followed this instruction and rang back several times over several days.  Each time I was given the same response and told to ring back.  Eventually I arrived at the office again to remonstrate with the gatekeeper.  I received another explanation of the system in time worn ‘bureaucratize’.  It dawned on me that I had taken directions from an addled caterpillar; waylaid in a Kafkaesque loop designed to entrap.  A massive lottery win was more likely than gaining a parking pass.  

I mention this as the daily grind of parking beggared belief.  The neighbouring streets operate under a fearsome parking meter regime, while the paid parking lots extracted a daily toll, which was manageable, or a prohibitive hourly rate.  The catch was if you did not arrive early enough to avoid a shift changeover you missed out, as the staff car park was wholly inadequate (yes, the one accessed by the mythical pass).  The labyrinth had revealed one of its frustrating gauntlets that most inhabitants run daily.  It felt like the mythical pilgrim’s hump – self-mortification by motorcar.

I kept asking myself  why a major public teaching hospital was in such disrepair.  At every turn, I found evidence of under-spending, poor facilities’ management, lack of maintenance and broken infrastructure. Public toilets were shoddy.  Outside the ICU, the only ceramic urinal in the only male toilet was broken, leaving one cubicle for all the anxious men in the vicinity.  This situation persisted throughout.  On the high dependency neurological wards, away from the ICU, I found similar conditions.  I had seen better kept facilities in developing country hospitals. 

On the surface the ICU facilities appeared excellent, although housed in old building stock.  However, annual budgets clearly only go so far; certain areas of maintenance just fall off the ledger.  I expect ICUs and surgery theatres, radiography, pathology and other specialist units take priority, once you allow for a salary bill for the high priced medical corps and less highly paid nursing cadres. 

It was concerning to see apparent neglect of key services and infrastructure, such as adequate and affordable parking.  The wards had insufficient beds, such that care protocols appeared to be relaxed to manage more patients.  It is passing strange that an affluent country re-elects politicians who peddle policies that lead to hospital neglect.

To be continued.....

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*              The Life Centre construction is now well advanced.  At the time of writing the complex utility underpinnings of cutting edge technology were viewable from the street in a maze of pipes and wiring conduits running in all directions.

Pool of Tears - Part three

Friends had kindly offered their living room as a bedroom for the duration of my Sydney stay.  All my waking hours were redolent with the whirring and machinations of life support and its indicators.  I ate reflexively; all social intercourse was cursory and frustrating.  Sleep provided no release.  I cried inside a lot. I thought of Alice:

          ‘I wish I hadn’t cried so much’, said Alice, as she swam about, trying to find her way out.  ‘I shall be punished for it now, I suppose, by being drowned in my own tears!  That will be a queer thing, to be sure!  However, everything is queer today.’ *

I often woke in the early hours to ring the ICU for updates.  My spiritual ‘toolbox’ was quickly exhausted.  During these dreadful nights, I pleaded with intangible entities, deities and saints of the Hindu and Buddhist pantheons, and other curative forces imagined and believed in by countless religious followers.  Unashamedly, I prayed to our home-grown Catholic saint and one of Carolie’s heroes, the educator Mother Mary Mackillop, to intervene in her survival. 

I had spurned organized religion most of my life, believing it to be more about power and control than spiritual practice, but this was different.  My intuitive brain yearned for spiritual succour.  Some comfort came from chanting and praying in the early hours.  Images of despair and anguish assailed me.  In his insightful “The Pains of Sleep” Coleridge # writes,  

                    But yester-night I prayed aloud

                        In anguish and in agony,

                        Up-starting from the fiendish crowd

                        Of shapes and thoughts that tortured me:

                        A lurid light, a trampling throng,

                        Sense of intolerable wrong,

                        And whom I scorned, those only strong!

                        Thirst of revenge, the powerless will

                        Still baffled, and yet burning still!

                        Desire with loathing strangely mixed

                        On wild or hateful objects fixed.

                        Fantastic passions! Maddening brawl!

                        And shame and terror over all!

                        Deeds to be hid which were not hid,

                        Which all confused I could not know

                        Whether I suffered, or I did:

                        For all seemed guilt, remorse or woe,

                        My own or others still the same

                        Life-stifling fear, soul-stifling shame.

My nights during the early days were frequently thus, without the poetic voice.  

I railed against a teaching service that required its senior teachers to work extraordinary hours to manage ridiculous workloads.  I railed against workplaces that tolerate bullying and undermining of dedicated souls.  I railed against an apparent obsession with comparative testing and reporting regimes for primary schools, rather than just focussing on realizing the full potential of each child.   

Burst aneurysms have other causes but logic was not shaping my nightly cogitations.  Again, caught between the need for rational explanations and an intuitive acceptance of pain and tragedy as merely way stations to a deeper understanding, I struggled to separate the real from the illusory.

I raged at my weaknesses, failings and sometime depressive responses to life’s pressures and difficulties.  Adrenalin and stress amplified the self-examination to screaming point; it was exhausting yet strangely cathartic.  I felt fragile, vulnerable, but the nightly angst seemed to help steel me against daily terrors.  I had not a clue what was happening; the psychological underpinnings were a mystery.  It was uncharted territory. 

In retrospect, I was struggling with ego. I needed to get beyond my hurt if I was to be a useful partner in the healing process.  I needed to get beyond ego to quell fear and uncertainty.  It was not about personal fear and loss; it was not an intellectual exercise in determining cause and effect; it was about finding the humility to sublimate the sense of ‘self’ that ruled my daily meanderings; it was about the essential unity of life.  

Plotinus, the founder of Neo-Platonism, illuminates the idea that “life begins and ends in a mysterious unity which surpasses our normal understanding”:

         

What, then, is it? The power which generates all existence, without which the sum of things would not exist, nor would intellect be the first and universal life.  What transcends life is the cause of life; for what activity of life which is the sum of things is not primal, but itself pours forth as if from a spring…It is a wonder how life in its multiplicity would not have existed unless before multiplicity there had been a simple principle.  The source is not fragmented into the universe; for its fragmentation would destroy the whole, which could no longer come to be if there did not remain by itself, distinct from it, its source.  Universally, therefore, things go back to a Unity.+

Of course I was not grappling with such weighty ideas at the time but, with hindsight, my nightly quest for answers evolved over the days, enabling me to find more humility and be less concerned with personal ego.  I could not have intellectualized any of this at the time.   

Something helped me get to the ICU each day; clinging to hope as a life raft in a pool of tears.

---

*              Lewis Carroll, Alice’s Adventures in Wonderland, The Folio Society, London, 1961, p. 16

#              Coleridge Selected Poems, Oxford University Press, 1965, pp 181-2

+              Tacey, op. cit., pp 84-85