Murmuring voices, rattling instruments, coughs, and the undertow of disinfectant weakens, sloughs into a muted distance. Appalling blackness metastasizes. My wife recedes down a lengthening tunnel.
Something is terribly wrong.
I arrived with Judie in the emergency room about half an hour ago doubled over, throwing up and beyond repair. An iron fist pulls, twists and shakes my gut.
I need morphine. I’m not a junky; I just need relief, and I need it now.
I’ve lost maybe ten pounds. I’m gaunt. I know from experience that morphine will jigger down the pain in my gut. I think I must be having another kidney stone rumbling along like a boulder through all my little tubes and pipes. But I can never be sure. It’s a lottery with me; kidneys, drug reaction, ulcer, spine, anemia. Who knows? I’m losing patience: slipping into rage is my artful way of sidestepping the anxiety and fear that goose steps next to extreme pain. I can’t stand or sit up. I can barely breathe. I have no idea how to tolerate this, no idea at all. Pain obliterates reason, turns you feral.
“Are you taking any medication,” asks Dot, the nurse, looking at her chart, as if maybe I’m on a piece of paper, not squirming in agony on the gurney in front of her. She’s already checked my pulse, heart rate, blood pressure and temperature. She also has the low lights of my medical history, so I think she knows what to do.
“Yes, morphine, right now if you’ll shoot me up.” Sometimes fear and anger can be wrapped up in humor, laid at the feet of the nurse, and maybe, just maybe she’ll like the gutsy attempt at humorous bravery in the face of sickening pain and stick me with the needle. I just can’t have her waiting, screwing around with the usual emergency room formalities. I tell myself there are no outward hints of the hurtling fear barreling down like a freight train on my stalled reason. I might be wrong.
Judie reads to Dot from my handy-dandy, ready for all emergencies drug list I keep in my wallet, all the medicines I take. It’s quite the little list and leaves Dot shaking her head.
Meanwhile, I’m hunkered down on the demented edge of pain where just about anything can happen: I will either demand morphine, pretending I have a gun pointing at Dot’s heart from under the blanket, or confess to killing Elvis, anything to stop this pain, this fear.
“I know you’re in a lot of pain, but I have to get this information to the resident so he can order the morphine,” lectures Dot in the same tone as my 7th grade teacher, Sr. Bloody Discipline, explaining to me the connection between obedience and heaven: “Of course God loves you, Mark, but to get into heaven you have to obey me.”
I know she’s seen truckloads of patients in extreme pain, but she has no idea what is happening to me. If I could reach up and grab her by the stethoscope, I would. Or I could just be honest and say that I’m scared to death that this pain will go on forever and that I’m afraid that she’ll forget me and leave me neck deep with stabbing switchblades. I could, but I’m too wrapped up in being a pain-maddened asshole to be truthful with anyone.
Judie steps in, knows from experience how desperate I am: “He’s right. He’s been through this a lot. The only thing that works is morphine. He really will calm down, but morphine is the only thing that works.”
“Let me see what I can do, I’ve already got a call into the intern.” Dot nods sympathetically to Judie, parts the curtains and steps away. I wonder if she’ll ever come back, as if she’ll get distracted with a two month old baby who stops breathing or a 23 year old newlywed who’s fainted at her wedding. I worry I’ll be abandoned.
“Help me up,” I struggle to get upright, “I’m getting out of here. If they won’t give me the fucking morphine now, I’ll do this at home. I’d rather be at home miserable than here and miserable. Let’s go.”
Even though my reason has been knocked miles down the track, I can hear the onset of panicked irritation in Judie’s voice: “What are you talking about? Are you nuts? We’re staying right here, you can’t leave, you’re sick. LIE BACK DOWN.”
“Fuck it, hand me my pants.” How I’ll stand up and walk is a mystery.
“No, we don’t even know for sure what’s wrong yet.” Then with more control in her voice, “Just hold on.” In spite of the pain I can see what I’m doing to her, it brings me back from the edge. I wonder how many times she’ll be able to do this with me.
I’ll just have to hold on. That’s it: “Hold on,” I repeat like a mantra. “Hold on.” But I’d rather be dead than go on any longer like this. It feels like a rusty spike has been driven into my stomach and is being shoved deeper, fiendishly twisted.
Hours drag past over the next few minutes. I stop talking. I rock back and forth on the gurney. I am untethered from the world, now. My mind has slipped free of my body. I’m floating, unworried about the patient I sent home earlier this morning, not worried about how suicidal she is. I don’t have to, I’m in pain. Don’t ask me to be responsible now, I’m in pain. Worry about the bills? Not me, not now, I’m sick. I can be as carefree as a four year old.
Leave me the hell alone!
Dot walks back in armed with an I.V. and a syringe. This hauls me back into my body. “O.K., we’ll be in business shortly, the resident will be calling in a few minutes. I’ll just get this I.V. going so we can get the morphine on board as soon as she calls.”
I love this language. “On board,” as if I am a freighter waiting to be loaded up with a couple of tons of cauliflower. Fuck that! How ‘bout a ton of morphine!
Dot scrubs and swaps the back of my left hand, preparing it for the insertion of the I.V. needle. I take this opportunity to do some lobbying.
“Dot,” I gasp between undulating waves of pain, “I know from…long and unfortunate experience that a little…a little morphine administered over a half hour or so just won’t…won’t do the trick.
“You’ve had morphine a lot?”
Yes, I nod agreeably, as if we’ve been compatriots all along.
“Then you know that I can’t give you too much, you’ll stop breathing. Not a good outcome.”
Judie again: “He’s developed a tolerance for it over the last few years, but it’s still safe to give him.”
“Think of me as a very large horse; a bucket of morphine will just about do the trick.” I lapse into silence for a few moments trying hard not to hyperventilate while Dot fusses with the I.V. needle. “I’m not saying…I’m a horse’s ass…”
“Perish the thought,” says Dot smiling. This is good, she’s joining me. Yes, this is very good. I try to focus my attention outside of my body as Judie holds my right hand.
As Dot slaps the back of my left hand trying to raise a good vein, I see that she has a small amount of morphine in the syringe lying on the tray next to her. Shit! This has no chance to work; the pain is stupefying. “Dot, what you’ve got there will…will do absolutely nothing. Really, just back up a tanker and run the fuel line in.”
“You’ve had way too much of this stuff haven’t you?” Dot slides the I.V. needle home, applies a super-stick tape to hold it in my hand and starts a saline drip from a plastic bag she’s already attached to the I.V. line. No morphine, though.
I can see I’m not getting anywhere. I am about to launch into my… CAN WE PLEASE JUST PLEASE TRUST THE DAMN PATIENT HERE, JUST THIS ONCE I KNOW MORE ABOUT MY BODY THAN YOU OR ANY TEN DOCTORS AND NURSES SO LET’S JUST QUIT SCREWING AROUND AND START RUNNING THE MORPHINE BEFORE I TURN INTO A SLOBBERING, INCOHEREN PAIN ADDLED LUNATIC JUMP OFF THIS GURNEY GRAB ALL OF YOU BY YOUR SCRAWNY THROATS DRAG YOUR SORRY ASSES DOWN THE HALL AND TOSS YOU INTO THE STREET SO I CAN HAVE ALL THE MORPHINE I NEED SO LET’S GET THIS GOING RIGHT NOW COULD WE PLEASE…however Judie must see the coiled dementia in my eyes and moves in: “You know, Dot, we forgot to tell you, he has Behcet’s Disease.”
She assures Dot that we have been through this many times, that normal amounts of morphine simply have no effect at all and she really needs to get permission to give me more than the usual. She also explains to Dot about the Behcet’s Disease. Judie tells her how this autoimmune disease wreaks all kinds of havoc and has weakened me in the last few years.
They talk across my body, Dot standing on one side of the gurney, Judie on the other.
“What else does it do?”
“It causes blood clots, horrible mouth sores, exhaustion and blindness. Pretty evil stuff.”
“How do you get it? Hereditary?”
“No one knows for sure, some think it’s hereditary, others that it might be a virus. Maybe there’s some underlying genetic structure that gets set off by virus or something. It’s really common among Turks and Japanese. About 1 in 500,000 gets it in America.”
Have they forgotten I’m down here? Has my body dissolved?
It’s like the first time you go to bed with that beautiful red haired, green eyed girl you’ve recently been dating. You are lying naked together in her bed with a candle flickering on a nearby table. A touch of patchouli hangs in the air. Her cheek is pressed against your chest and her small, delicate hand is moving down your stomach, and all that passion you’ve been saving up for her is just about to unleash when the phone rings. Her warm fingers leave your belly as she reaches, oh god, no, for the phone. And just like that she’s chatting away with her best friend…about YOU.
“Look,” I say trying to appear calm and polite. “I know this disease is fascinating but I have a kidney stone or something, right? On the left side. I’ve had them a half-dozen times. I’m an expert at this. Just give me the morphine, wait a couple of minutes ‘til I calm down and then I’ll explain the whole disease. But right now, forgive me, please, but give me the damn MORPHINE.”
Dot, close to amusement at my behavior, ignores my rant and repeats to Judie that as soon as she gets the o.k., she will gladly inject me with the morphine. “We just have to wait.”
“We,” I shoot back, proudly riding my indignation, “we know full well that the waiting will be done by me.” Mocking the angel of mercy, however misguided I think she is, is never a good tactic.
“Don’t worry,” she repeats, “as soon as I get the o.k. it’s yours, I promise.”
The wait is short and “we” have been lying on the gurney strangling the life from Judies’ hand. The phone rings and Dot answers it. I’m so far beyond the frontier of social convention that the brevity of the wait fails to embarrass me. Later Judie explained that this time interval was not the five minutes I had thought but thirty minutes. I hear her explain my problem, say “Thanks,” and hang up. She takes the hypo inserts it back into the morphine bottle and increases the amount to 7 milligrams and approaches my IV. I lift my head up an inch or so off the gurney to watch as she slides the needle into the little plastic port on the I.V. tube half way between the I.V. bag and my left hand. I continue to watch in sudden gratitude, social conventions returning just in time, as she slowly applies downward pressure on the hypo’s plunger with her thumb. The morphine begins to disappear down the tube into my waiting vein. Oh yeah, here it comes.
I feel sudden heat in my hand where the I.V. needle enters my vein. This passes and is followed by a slight choking sensation in my throat. My head feels like it is expanding, accompanied by a wave of nausea that eases as quickly as it comes. I settle back against the pillow and wait for the familiar dizziness to pass.
“I hate this feeling,” I whisper to Judie who hasn’t strayed from my right side. But the feeling passes after a few moments and a warm feeling of well-being spreads throughout my body. A delicious heaviness creeps along my limbs. The lion is no longer sitting on my chest growling hungrily into my face, but behind bars and a moat. I still hear its growl and smell its foul breath, but I’m out of its reach.
I fall silent, enjoying the exquisite numbness. My breathing evens out and my rigid body begins to relax. I double-check to make sure the lion is caged. Convinced, I allow myself to look up at Judie. My relief is mirrored in her eyes. “I’m o.k.,” I smile, hoping to erase all the panic and rage that has just passed. The fear is narcotized, I’m beginning to feel human. I want to kiss Dot, pledge my undying devotion, marry her, raise our children and care for her in her old age. Wisely, I say nothing.
“How are you doing,” Dot asks, looking transformed, like Susan Sarandon in the movie Lorenzo’s Oil.
“O.k.,” I whisper with some effort, as if morphine, like a good friend went right to my vocal cords to save me further post-pain embarrassment.
“I’ll check back on you in a bit.” Dot pats my arm, knowing all along that it was fear and not rage that swamped me. She smiles at Judie and glides out through the curtain.
Judie repeats the question and again I nod. She lets go of my hand and begins to straighten up my clothes, an hour ago tossed in a pile on an empty chair. She’s preparing for the long haul, for my expected treatment in the emergency room and my eventual admission into the hospital. Judie knows the routine all to well. She readies herself for the watchful waiting that will be hers for the next few hours. They should give her the morphine; it might ease this for her. She pulls a chair up next to my gurney, sits down and pulls a bottle of tea from her bag.
I know her routine, the way she immerses herself in the mundane details to flatten out her fear: insurance forms, arranging time off from work, notifying my patients of my absence, talking with the doctors. I can see the fear and anxiety peeking up through her eyes like small children with their hands over their faces trying not to look at the monsters on a movie screen.
I should try to be reassuring, like, “Hey, babe, no big deal, we’ve done this before, we’ll just have to do it again. I’ll be fine and back to work in no time.” But this won’t erase what has just happened, it never does and I feel guilty that I can’t relieve her anxiety. We both know this and it hangs like a lengthening shadow in the unsaid spaces between us.
Several minutes pass in silence, me with my morphine, Judie with her appointment book. “Do you need anything?”
Yeah, I’d like to shout, my body. I want my body back. Instead: “No,” I whisper, the whisper the result of the morphine, or lying, or both.
She stands up next to the gurney and pushes my hair back from my eyes. “We’re going to be here for a while, mind if I head for the restroom.”
“No,” I feel better as the morphine slithers through the pain. “Don’t worry; go ahead, you know that this is going to take forever.”
Judie arranges my blanket and takes my hand again: “Are you sure you’ll be all right.” I nod yes, but more slowly. This time the effort it takes to nod exhausts me.
The delicious heaviness I felt before spreads, deepens. But I feel oddly sluggish, weighted. I am expanding and shrinking at the same time like the Northern Lights rolling out through the night sky, contracting, rolling out again.
Ordinarily after a hit of morphine I feel dopey, relaxed. But something’s a bit off. Panic ignites, dissipates like the flash of an old fashion camera. Things look odd to me, somehow off, out of tune, maybe. Shapes shimmer, bleed into each other, shimmer and bleed again: Judie winks in, winks out. Something’s happening, and fast.
“I’m going to the restroom just down the hall, I’ll be back in a moment,” I hear Judie say from a great distance. “Don’t go anywhere,” she chuckles as her fingers slide away from mine.
Something is terribly wrong.
I hear myself say, “No, Judie, don’t go. This isn’t right. Listen, you better stay close, something’s wrong here.” But nothing comes from my mouth, nothing. How can this be?
Time and movement dissolve, as if the world stopped spinning on its axis. I try to reach out with my right hand to stop her, but my arm won’t move under a gathering weight. Judie smiles over her shoulder, reaches out with her left hand, parts the curtain and steps away. A warm ocean rise up, embraces me. I begin to sink, as if I will sink forever. I’m in blackness, I can no longer see, or hear. The fear is gone. I’ve stopped breathing. I am utterly alone.
Something slips away and I simply know. There is no shock, no regret, no sadness. There is nothing at all. I wonder if I’ll see a bright light or my dead brother coming to lead me. But I don’t. Instead, with no body, no emotion, and no place in this world I become nothing more than a fading thought: There’s nothing to be done, I’m stopping, I’m stopping…