Sitting in the cafeteria is an interesting experience. Attendings and residents mix with patients and the still obviously nervous interns; the intern nervously asks for permission to do a procedure and gets the okay, while only two feet away a doc asks how a woman in a wheelchair and on a drip is doing, and obviously delighted to see her eating. Pocketed here and there are the numerous support staff that are necessary for the hospital to run, and sitting in the middle of this swirl of talk and activity, I sit and watch.
There has been an emphasis on bioethicists as mediators, listeners, but also watchers. People in the background, looming quiet but a promise that should there be a need, they’ll step in. To wear my geek-hat for a moment, sort of like the Organians in the original Star Trek. Keeping the peace. Negotiating borders and boundaries between the Klingons and the Romulans and the ever-expanding Federation. The lightbulb-heads. They were a better constant threat than Q ever was for The Next Generation; or at least more beneficent.
But the question, asked nearly 30 years ago, remains valid: who watches the watchers?
Lying in bed right now. I borrowed a book from the AMBI conference room on my way home today, along with the last issue of AJOB. I was planning on catching up on AJOB, then review the Dax literature I have before tomorrow’s lectures by Dax (something I’m still amazed by), but have instead been reading John Lantos’s book The Lazarus Effect, the aforementioned borrowed book. I like reading books like this; the “true crime” novels of medicine, I guess. They remind me of why it is I want to do what I want to do (convoluted sentence), and keep my humanity grounded. And the subject, the NICU and theories of agency and life and death, seemed fitting with my NICU visit today.
I was quite impressed with the AMC NICU. Dr. Harndon (whose name I’m probably spelling wrong) was more than willing to answer any questions we had, and to let us get very up close in looking at both the infants and the equipment. I feel quite privileged to have been able to spend as much time as we did with him. NICU has certainly advanced, technologically, since the last time I was in one, and there were quite a few wee ones in there. Which, of course, brings about its own questions and concerns. The big one, of course, is how young is too young to save — something that Lantos is addressing in this book. At what point do we decide that the life is too hard, too little a life, or not a life at all, just a biological machine running on autopilot? And who has the right to make that decision? We see, at St. Margaret’s, the volume of children and young adults in these depleted if not completely absent states, some no more than biological machines, and yet they’re nurtured and cared for and kept alive for — what? Do we truly place that much value on life, that it has to occur at all cost? (And if we do, why do we show such hypocritical behaviour with the death penalty?)
A friend of mine when I was much younger was a preemie. She was tiny, and always would be tiny. Born two months early, in the early 1980s, she had remarkably little damage from being a preemie. But, like I said, she was tiny — short and petite. Her bones were fragile, and she had some minor neurological issues; suffered from seizures, if I recall correctly. She was a happy person, and lived a largely full life. Couldn’t drive because of the neurological issues, but otherwise was fine. And, as her parents would tell us, lucky. They’d had a preemie before her who hadn’t lived.
I wonder how much of our current attitude towards premature infants is because, of all things, Xavier Roberts, the Cabbage Patch Kids, and that particular line of dolls: the preemies. Dolls that were wee, that you had to take special care of. I wonder what sort of subtle psychological effect it would have, to play with dolls called preemies when you’re a kid, and then go to have a premature infant as an adult — do you link the two together in your mind, and push cuteness and delicate, doll-like features first, and ignore medical ramifications of being born very early?
A little later now. I was comfortably reading, cats at my side, nodding off in that warm haze that comes when you’re tucked in and ready for a day to end, when my winding down mind drifted to UW, and I realized with a start that only comes in that half-sleeping stage that I couldn’t instinctively trace, mentally, my route to Padelford B103 — the CHID office. It actually took a moment to recreate the steps past Mary Gates, under the arch connecting the Allen Library to Suzzallo, across the top of the HUB lawn, curving around Communications before crossing the street into the comfortable maze of PDL. Panic, sheer and sudden — what was wrong with my brain? In bed, had I had a stroke?
The weather is cool, right now, and a light breeze is blowing in my window, and across my skin. Cats, bed, light, breeze — everything constructed in such a way that my closed eyes and befuddled brain didn’t remember, for that fear-causing moment, that I was no longer in my Seattle apartment, tucked on the Hill and just out of noise of the nightlife. Sleepiness robbed me of the memory that it’s been three months since I walked that path, smelled the particular tarragon-sage scent of the bushes or dodged bold squirrels.
I sat alone at lunch today, tucked into the corner of the AMBI front office. I had to talk with Lisa, to schedule a meeting, and then stayed to use the wireless network; Sheila and someone had been in the conference room. It was around 10am Pacific, and I was able to talk, via AIM, with several friends I’ve not spoken to in real-time since I moved. Although my sister has lived in Philly for seven years now, it never really occurred to me how different the time difference is. I wake up when many of my night-owl friends are just getting to sleep; I’m home before they’ve finished lunch, I’m in bed before they get home from work. Keeping in touch is not as easy as I had hoped.
So I sat alone, and on my computer — not working away hard, as Bob had thought, on something important for the ProSeminar, but something important for my own sense of self and wellbeing: catching up with someone who means a lot to me, someone I’ve not been able to talk to. One of my closest friends, and someone I do miss.
I mentioned last week that homesickness had not kicked in, except perhaps for CHID. Today, it sunk in the rest of the way. I’ve been on edge all day, and near tears. Not for any reason related to NICU — I’ve been there before, and it was nothing too new or surprising; if anything, the babies were healthier than I was expecting. But because I’m tired, I’m exhausted, I’ve had little break. My house is an unpacked mess, I can’t find anything, I can’t even eat at home — I’ve not had a home-cooked meal since July 27th, and I haven’t cooked for myself since June 5th. I’m frustrated with people, I want to say things I know I shouldn’t, and I’m starting to behave irrationally. And the underlining emphasis of that is that I want to sit down, in a dark corner, and cry and cry, until I can’t anymore. And this, Bob, is the big difference between knowing people here in Albany, and knowing people in Seattle — in Seattle, the moment I felt that need to cry, I would have been able to find one of several close friends, via some contact medium, and talked out what is bothering me.
In Albany, it took nearly seven hours and the forgetfulness of sleep to realize I don’t instinctively remember the steps to a dance I made for 2.5 years, and that for all my wishes otherwise, Seattle is becoming nothing but a memory.