Wednesday, March 29, 2006

Of Train Wrecks and Ghosts

He's alive, but the quality of that life has diminished to a degree almost unfathomable. He sees me for the first time in weeks and says, "I'm hungry and they won't feed me." How do I explain to him how his lower esophagus disintegrated under the pressure of uncontrolled vomiting and that he must be fed directly into his small intestine, bypassing the stomach which now has no connection to his mouth which craves food and drink nonetheless? How do I tell him that his cocaine and heroin addiction, poor self care and choices have finally come home to roost, and that all of the warnings we gave him over the years were real? Can I tell him that he will probably live in an institution for the rest of his life, and that he cannot expect a whole lot more from life for a very long time, if ever? Is it my place to explain that his hands are in large cotton mitts and his wrists tied to the bed-rails because, in his paroxysmal and violent detox from cocaine and heroin, he actually ripped a chest tube from his rib cage, causing further lung collapse and trauma? Yes, he is hungry. His stomach naturally craves food, as do his lips and tongue, but there is no passageway from that mouth to that stomach, that center of our bodies which we use to satisfy cravings of so many kinds. That stomach, lonely without an esophagus, does nothing but drain mucus through a tube inserted through its wall.

Did anyone say train-wreck? It was expected---he had been hurtling blindly down that track for years. But to see the fruition of such self-abuse is startlingly real. Harsh is barely appropriate to describe its glaring severity.

An urgent page interrupts my bedside visit: she is 48 hours clean from crack cocaine and just punched a hole in the bedroom wall. With kids at risk of being removed by social services, she begs for something to assuage her anxiety as she climbs the walls of her mind. She's been doing so well for so long, but the ghosts of trauma past have surfaced once again and she has devolved into practices which we all know will kill her. Eventually. This woman's body craves healing, and we have beaten back the HIV and brought it to its knees, but I know from the visiting nurse's report that she has eschewed her medications for almost a week now. Sure, we'll give her some Seroquel to calm her down, but she must pursue the avenues which I have opened for detox, psychotherapy, and the recovery she so desperately needs. I hurt for her, even as I silently and internally process my profound disappointment and sadness.

Oh, the trauma of broken lives and misdirected grief. The sadness and suffering that permeate these lives is profound. Among so many of us out in the field, a profound wish to "fix" exists, and we run up against our frustrations time and again. These scenes of suffering can wound us as well, driving us to further feats of attempted healing, but also to stress-related illness and burn-out. My mind burns with these scenes, and even after losing twenty minutes of writing on this troublesome computer, I return again to try to record these thoughts before the machine betrays me and my work is lost in the digital ethers a second time.

There are countless stories, and each day brings a scene worth a thousand words and a thousand feelings. This brief interlude before sleep allows me to unload a small portion of the crowded contents of my mind. Yes, human train wrecks walk this earth, as do the ghosts of others gone before them. Some of us chase those trains, some of us chase ghosts, some of our patients are haunted by ghosts as yet unidentified. Human tragedy unfolds, and we are sometimes powerless to change the course of the train as it blindly hurtles towards the wall directly in its path.
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