Late-Night Thoughts

Many are the wonders of having a physical body. The scent of flowers, the feeling of grass on the soles of one's feet, the taste of a favorite food, a glass of wine, the gaze of one's lover, the feast of looking at art, the crunch of a cucumber. Physical existence offers such breadth of experience, such sensual delight, such a plethora of feelings and sensations building one upon another in a crescendo of stimulation and experience.

And there are the disadvantages, the ways in which the physical becomes burdensome, even painful. A cyst grows on a nerve root in my lower spine, causing incessant contraction of muscles that are like ropes under the physical therapist's fingers. A malfunction in the junction of my esophagus and stomach allows gastric secretions to bubble up and cause me discomfort. My step-dad's pancreas harbors an uncontrollably growing mass. My dog's kidneys failed, and twenty-eight days ago we eased his spirit from his tired old body and placed that beloved furry body in a hole in the earth. The ache which I feel from his absence is like a physical pain, although I know that it is not.

Life offers such contrast, such dichotomy of feeling and experience. Most of us would agree that it is better to have loved and lost then never to have loved, yet in that moment of loss it seems the pain will last forever. In the joyousness of health we leap through life and take our bodies' wholeness for granted. And when illness strikes, we long for the carefree days before we felt betrayed by that collection of cells we call our own. But is it truly a betrayal, or simply just another way of being in that body, of embodying our own existence?

Of course, we in the health and medical fields see optimal health---physical, mental, spiritual---as the goal of our work, and the desire of all. But there are those who seem to suffer---often from birth---from afflictions and illnesses over which they have no control. And even those individuals find meaning and purpose in life, often in spite of, or perhaps because of, their suffering.

At birth, our parents hope to see ten toes and fingers, an even number of limbs, hear a healthy cry, and observe us engaging the world with that first magical breath that transforms us from an aquatic cosmonaut to a terrestrial creature with feet on the ground and head in the sky. This long process called life offers such opportunity, such room for growth and transformation, and as parents we hold a vision of life without pain and suffering for our offspring.

But this business of having a body brings with it great risks as well. Illness, suffering, pain, loss, malfunction, death---they are all here with us on our journeys around the sun.

Working as I do with the chronically ill, I see some of the worst things that can happen to a body, the afflictions and struggles which can beset a human on his or her trajectory through this earthly existence. I can only conclude that there is great beauty in life---even in death---and that suffering, in its myriad forms, offers its own stark beauty, its own language of learning and growth. Still, I mourn for those who suffer needlessly, who experience torture, rape, brutality, and other unspeakable indignities, and I hope that even those who suffer so, when released from that suffering, know a peace beyond that which is imaginable for us remaining here on this three-dimensional side of the veil. My hope would be that it is so.

I will take the years offered to me and try to use them well. Pain and suffering be damned, there is nothing else to do but take this life in my own two hands and shape it with the force of my will. On this third ball of dust from the star we call The Sun, our lives unfold as so many stories of bodies and minds and hearts in motion. In pleasure or pain, life is what it is, and we simply take each day and live it as our truth, since no truth can be clearer than the one confonting us in the mirror each morning. And when you look in that mirror tomorrow, what, pray tell, will you say?

Housing Hell

I watched the cockroaches crawl around the clean laundry in the basket next to the couch as I took my patient's blood pressure. I noted the single-pane windows, wondering about the coming winter's bitter cold. My patient complained to me that this apartment--to which she moved after we requested a first-floor apartment for her---has floors which are harshly askew, causing her to fall frequently.

I wandered around the apartment, noting clearly that the floors do indeed slant in one direction or another in each room, at times to a considerable degree. Her daughters, able-bodied and young, say that even they sometimes lose their footing from the missteps they take on the floors which are not unlike those in a carnival fun-house. My patient, who suffers from arthritis so severe that she receives intravenous chemotherapy every two months, has a difficult time negotiating the apartment, a cause of much frustration and anger on her part. This move to the first floor from the fourth is fraught with new challenges, and perhaps has been for the worse.

When I first met her, she lived in the building next door on a fourth-floor walk-up, the stairs becoming an increasing challenge as her disability worsened. I drafted a strongly worded letter to the landlord asking for urgent placement in a first-floor residence, or a building with reliable elevators. The landlord responded quickly but didn't even give her a chance to see the apartment. Before she knew it, she was moving, and the askance floors were immediately apparent. Several falls later, I'm considering my next steps. This is housing "approved" for Section 8---hasn't it been inspected? Are there structural problems with the underpinnings of the building which might endanger those on the upper floors? There is obviously something wrong. While I am not a social worker, these are battles I often choose to wage, and this one may cost me a great deal of time and effort. But if she breaks a hip, all hell will break loose and I want to head that disaster off at the pass.

Substandard housing for the poor is commonplace all over the world, and the United States is sadly no exception. Even low-ranking soldiers in the military live in government-issued housing that most of us would find unacceptable. When did viable housing become a priviledge in this society? Probably around 1492.

In my time as a nurse working in the community, I have seen some housing situations which were utterly appalling. An older gentleman with a unilateral leg amputation who I used to know lived in a hovel behind his nephew's house, wheeling himself over floor-boards decrepit with age and rot, a large hole in the bathroom floor daily threatening to swallow his wheelchair. I've seen rats, cockroaches, holes in floors, broken windows, missing locks, lack of ventilation, stifling heat in summer, lack of proper heating in winter, the list goes on. Granted, some public housing is abused by some tenants, slums becoming such when they are neglected and trashed by uncaring residents. But one must look sociologically at the source of the rage that damages such properties. As I have said before, those who feel cast aside and uncared for by society will, by default, be uncaring for their environment, and perhaps for their own well-being. Our responsibility to house the needy is enormous, and we are, in my estimate, failing miserably on many fronts.

There are some examples in our area of excellent housing for the elderly and disabled. Nicely maintained, with common rooms, landscaping, excellent security and organized social gatherings, these residences could serve as models for others. On the contrary, one year after Hurricane Katrina, there are still squabbles about what type of viable housing---aside from FEMA trailers--- to provide for those displaced by the storm. Luckily, some groups of service-oriented architects are creating models of cheap, durable housing which can be freely copied and altered---in a manner similar to open-source freeware on the Internet---a practice which may transform the idea of affordable housing for the future.

But that future seems far away as my patient slips and slides along her not-so-fun-house floors, and my rising ire against a corrupt system which provides such abominable living conditions for the most vulnerable among us slowly turns to rage. The housing authority in the city in which I work has lately been revealed to be rife with corruption of the most reprehensible kind. A prominent family bilked the authority of millions of dollars over many years, allowing said family's members extravagant home improvements while the poor of the city languished in substandard dwellings. For those individuals who were sent to jail, good riddance, and their post-release community service should include five years of living in the worst of the public housing for which they were responsible creating and maintaining in its sorry state. If that type of corruption is not a source of rage, I don't know what is.

So, it seems that for all of us out there fighting the good fight on behalf of those not able to fight on their own and win, there are others who will take advantage, corrupt the system, and provide shoddy work and horrible conditions in the interest of saving money and advancing their own wealth. If it didn't make me so angry, it would bring me to tears.

Someone might ask, is this what a nurse does? Is this how a nurse thinks? Should a nurse even involve him- or herself in such societal issues? The easy answer is "of course". Physical, emotional, and spiritual health has myriad aspects and properties, and the health of the home, the place where one rests one's head, has an enormous impact on one's sense of health, safety, and groundedness. A home which does not offer that which a person needs for their own protection and security and comfort is a home which lessens that individual's ability to be whole, to be productive, to feel valued.

The frustration in the eyes and voice of my patient who is negotiating those off-kilter floors is filtering down into her sense of self, her sense of her relative health, her well-being, her groundedness. How can one feel grounded when the floor beneath one's feet can fool the eye and the foot? Housing certainly is a right, not a priviledge, and those rights are generally worth a good fight. I think I'll be taking off the gloves tomorrow.

Dizzy-less

I guess the spiritual Dramamine worked. The vertiginous feeling subsided and the working week began without dizzy spells, despite a poor night's sleep.

This is the second week which has begun gently, without the Monday morning explosion of need that can at times feel crippling. I even had spare time to offer a co-worker help with some debilitatingly tedious paperwork. That's one for the karma bank, I guess.

Each month, I try to at least make some effort towards contact of every patient on my caseload. Using the small spreadsheets that I've created to assist with this task, I keep track of who's been contacted, who's MIA, who hasn't returned my calls, who doesn't have a phone and was sent a letter. As the end of the month nears, I peruse my lists for a snapshot of the month's heavy hitters and frequent flyers, and it is blantantly clear who has not surfaced at all.

In care management, case management, and any situation in which many people are on a panel for one provider, it is always classically the squeaky wheel who gets the grease. The patient who calls incessantly, makes alot of noise and demands action---that's the person who consequently gets the attention. Most of those attention-getters are savvy and know how to capture me and focus my gaze in their direction, and their efforts are generally rewarded. For those who abuse it, they may be reprimanded gently and asked to consolidate their multitude of calls into just a handful, saving up problems and questions for a once-weekly check-in.

One patient of mine is very dear to my heart. She has multiple medical problems which are not necessary to this story, only to say that her pain and other symptoms cause her considerable distress and worry, leading her to schedule a plethora of appointments, often unnecessarily. Her children also have many medical and psychological problems themselves, and at times I wonder if she may display some symptoms of Munchausen Syndrome by Proxy, although I'm also aware of a movement of mothers who advocate against unnecssary and false allegations of Munchausens. That said, it's a very sickly family no matter how you look at it.

In terms of squeaky wheels, I guess she takes the prize, calling me with the most trivial news. To wit, "I'm just calling to tell you that the pharmacy only had ten of my pills and I'll have to pick up the rest tomorrow," or "I just called for my refills and they'll deliver them on Friday." Her sweetness and childlike innocence prevent me from getting too annoyed, and I occasionally ever-so-gently request that she not call with such trivial messages. I counter these comments with praise for her ability to keep track of a multitude of appointments and prescriptions needing constant attention and vigiliance. She may be a little mentally slow, but she is anything but disempowered. She may be a squeaky wheel, but she does it with such innocent guilessness. She really is a peach.

There are enough moments of sweetness and connection to keep me afloat, even amidst the onslaught of stress. I have to hold onto those moments like oases in the maelstrom, and try to let the stress simply flow by instead of drowning me in its tumult. Today was a success in that regard. May tomorrow be moreso.

Vertiginous

vertiginous \vur-TIJ-uh-nuhs\, adjective:
1. Affected with vertigo; giddy; dizzy.
2. Causing or tending to cause dizziness.
3. Turning round; whirling; revolving.
4. Inclined to change quickly or frequently; inconstant.

Dictionary.com is a wonderful source of fodder for the fatigued blogger, and today's Word of the Day sums it all up nicely.

These last weeks have been vertigo-inducing, with stress, sadness, grief, and anxiety to the fore, not to mention physical pain. At work, the constant river of complaints and maladies coming from my patients often manages to distract me from my own preoccupations, sometimes thankfully, sometimes annoyingly so. Sometimes I resent the distraction, and just want to focus on me. But for those eight hours each weekday, my needs and life take an ersatz back seat. Such is a life of service.

The dizzying pace of work often erroneously precludes self-care, and work at times seems to diminish rather than augment one's personal life. This is an unfortunate but true reality for many of us who work outside of the home and absent ourselves from our personal lives for nine or ten hours each day. Just trying to take time to call one's doctor or arrange a personal appointment while at work can seem like an enormous undertaking. When one works all day forty minutes from home, how does one take the dog to the vet, care for sick children, go to the dentist, pay bills, advocate for ageing parents, and otherwise manage the complexities of life? This daily separation from the needs of the homestead and family can weigh on the soul.

Now, we can't all be farmers living and working on our own land, and most of us wouldn't want to, anyway, and many a farmer would tell you that the lifestyle and hard work is not all it's cracked up to be. Those who are self-employed and work at home might long for an office to escape to, away from kids, dogs, laundry, and the myriad distractions that working at home would offer. At home, it would be so easy to decide to wash the dishes or organize the closet rather than get down to work. It's a wonder so many of us are unhappy and stressed. Are we trapped in a world we never made? Or are we simply not made for the world in which we are trapped? Nonetheless, here we are, and however vertiginous, our lives are of our making, our design. It's only a trap if we see it as such. Imprisonment is in the eye (and heart or soul) of the beholder.

So, at this juncture, at the dizzying age of 43, feeling set upon by the vicissitudes of a responsible adult life feeling slightly beyond my control, I will take my spiritual Dramamine and call you in the morning. Thus warned, I wouldn't blame you for leaving the phone off the hook.

Autumnal Musings and Confusions

Autumn arrives today with a cold rain and threats of frost over the last few nights. The rain precludes lighting a candle at sunset on my dog's grave---something I have done almost every night since his passing 21 days ago---but we can still light candles for him indoors with the same sacred and loving intention. The spirit world does not stand on ceremony, at least in my definition of such.

As summer comes to an end, the days of kids playing in the water park adjacent to our clinic also cease. Now hordes of children file past our office at 3pm every afternoon, backpacks and books over some shoulders, many sheets of paper and homework strewn on the already littered ground. Once past the crossing guard near the school across the street, the kids stream through our busy parking lot, slipping between cars, darting into traffic, locking eyes with drivers and silently challenging them to do anything about this daily invasion of youth. What worries me are the reckless drivers---both male and female---throughout the city where we work and thankfully do not live. Traffic lights and stop signs seem to mean little. Forget yield signs. They may as well not exist. Crowded residential streets are just freeways, and as a driver, I am often challenged by cars coming in the opposite direction who seem to intentionally drive in my lane, forcing me to slow down to avoid a head-on collision. It's chaos, and makes our crowded but rather pedestrian town look like a haven, which it is not.

Outside of our office yesterday, a fight between two boys broke out, a crowd of at least 100 kids quickly coalescing around the protagonists. We have broken up a number of these fights over time, and it seems that whenever we do so, one of our windows is invariably broken shortly thereafter. So yesterday we called the clinic security officer and he called for a cruiser. Our Latino colleagues with whom I work seem to take these periodic fights nonchalantly and are hesitant to get involved at all. Having grown up in Brooklyn, The Bronx, and elsewhere, they see these youthful turf battles as normal, although I'm sure they advise their own children to steer clear of such violence. I usually want to run outside and break it up, but they warn me that these days middle-school kids can be just as likely as teenagers or adults to carry knives or guns. However, just the sight of an adult with an official badge and a stethoscope around the neck can end most any fight. But am I just another example of a white do-gooder imposing my culture and ideals on a community where I don't live?

Other autumnal signs are the mums which were planted in the front of the clinic to spruce up the landscaping. Within several days, a few of the plants were dug up and stolen, a few others simply mutilated. Our landscaping is often vandalized, and sometimes I wonder why we bother, already spending hundreds on new windows and paint to cover graffiti. One must choose one's battles carefully.

Working in an area where poverty is prevalent, one becomes inured to litter, trash in the streets, the detritus of drug use, used condoms, and vandalism. Our office has thankfully avoided any broken windows for over three months after a rash of violence that cost us several thousand dollars. The schoolchildren fight periodically, the plants are stolen, the sidewalks plastered with school papers dropped like so much forgotten junk. I see families with small children walking along, the parents equally tossing candy wrappers, bags and juice cartons to the round, modelling for their children behavior which can last a lifetime. It can all come down to one notion, I guess: if you feel undervalued by the world and society at large, you will in turn undervalue that world yourself. You may even undervalue your own health. And that's where it comes around and bites you on the bottom.

I try not to be jaded. I try to approach these situations with a fresh perspective. I endeavor to also exmaine my own motives and reasonings. Today the beginnings of Autumn bring some sadness and a sense of loss as the deneoument of Summer comes to its anticlimatic completion. But here we are, and here we remain. Welcome Autumn, and may you lead us gently into the deep cold days of Winter.

Hitting Home

With my step-dad diagnosed with inoperable pancreatic cancer, my nurse's brain is turned towards family. With me five hours away, my sister fifteen hours away, and my brother one hour away, there's alot to finesse and figure out about how his care will unfold. I will not go into specifics here as it would be unproductive, but I will say that I now find myself in the position of acting as Nurse Care Manager for my parents.

Emails are flying back and forth between the sibs and their spouses, trying to come to terms with the challenges ahead. One of my personal edges is figuring out how to think clearly and clinically about the situation, not losing sight of the fact that this is my loved one who is the source of my concern and interest. The difficult and somewhat contradictory trick is to not let my emotions cloud my thinking, while at the same time not let my clinical focus supercede the emotions which are now understandably reeling.

Based upon my observations of patients receiving dire news and undergoing life-transforming and potentially debilitating treatments, the astute nurse must treat the family as a system and contend with the problems at hand systemically, holistically. Now, I have no illusions that I can do that, but I do see that I carry the most medical information in my head, and have the greatest understanding of the system, the treatments, the potential roadblocks, and the places where I consistently see errors made.

Obviously, I want to forsee as many areas of challenge as I can, attempting to head some of these wild horses off at the pass, perhaps even completely avoiding some problems which might otherwise have reared their ugly heads. But I also realize that, in my human frailty and emotional connection to the situation, I can only do so much. There are other professionals who I might elect to pull into this process, and the family will all pull together to see this through to whatever end we must.

The reality of the situation hits home, and as I attempt to orchestrate what I see as necessary to arrange, I grapple with the emotions which now swim in my already crowded mind.

I pray for peace and clarity, and freedom from suffering for all.

Navigating the Seas

They all seem to be navigating the seas of illness and the healthcare system. Doors close, doors open, opportunities are squandered, some forever lost. We serve as lighthouses, buoys, but sometimes even we can't save them.

There are surprises: a patient will take it upon themselves to advocate, to go after what they want, self-refer if need be, and make enough noise to be heard above the din. Of my eighty-three souls for whom I have been given some modicum of responsibility, the squeaky wheels do indeed get the grease. The ones who call constantly, ask for help, push for results, they receive the lion's share of my attention, by default. The others, the silent ones, they get drummed up when I have time to pursue them, as I poke in the corners of my case-load for hangers-on who just don't seem to connect the dots, or perhaps care not to do so. Even so, I seek them out and attempt to shine the light of compassion upon them. Some refuse, and they stay in the corners, still on my radar, faint bleeps of presence on the periphery.

Meanwhile, as some hover in the wings, others enter stage left with a flourish, demanding attention, flaunting their needs, shouting their ills to the seats in the balcony. Me, I'm in the orchestra, and I heed their call and strike up the band to accompany their soliloquy, make sense of their chaos, and elucidate what costumes and props we'll need for the next scene. Some scenes necessitate elaborate choreography, others are like a play by Sartre---stark, without affect, moving yet in no need of ostentatious staging. Still others are like a scene from Fellini, too difficult to describe----you just have to be there.

Our office would make a great prime-time drama: "Nurses on the Edge". There's drama, sex, violence, gangs, passion, drugs, crime, wisdom, tears, uproarious laughter. I think I'd want to be played by Ben Stiller (he played a Jewish male nurse in Meet the Parents, after all).

These seas are rough, and today I longed for a life-boat, or at least to exit gracefully stage left. But before I mix any more metaphors tonight, I'll simply admit that it's a wild ride, and I guess I'll hang on for dear life for a while longer. The life-jacket's at the ready, the life-boat a resume away.......

Courage

"Courage is a weapon we must use." ---Over The Rhine

The Cowardly Lion of Wizard of Oz fame got it mostly right. Courage is indeed part and parcel of living a full throttle life, and it's something we must cultivate from day to day, moment to moment, as life challenges us and throws its ubiquitous curve-balls. And sometimes those curve-balls just keep coming.

Yesterday I travelled to a relatively distant Northeastern city to accomany my step-father to an appointment at a large hospital. He has what turns out to be a inoperable tumor of the pancreas---inoperable because it's wrapped around the celiac access artery, making resection too risky. Thus, chemo and radiation ensue, and if that doesn't call for courage, I don't know what does.

For many, simply getting out of bed in the morning is an act of heroism. For all the talk of heroes these days---whether they be of the costumed superlative type, or the anonymous garden variety public servant who rushes into burning buildings to save strangers---there are many among us who have been, are, and will continue to be unsung, perhaps only to be feted by their loved ones upon their passing from this earth, that is if they have loved ones to celebrate them at all.

Pain, infirmity, loss of function, economic loss, grief, loneliness---so many are challenged by these life-limiting effects of disease and death. Still, so many also simply wake up each morning, set feet upon the earth, and move through yet another day, perhaps lucky enough to be kissed by sunlight or breeze, take a few moments to touch the soft fur of a dog, or feel the tickle of a dragonfly taking momentary respite on the back of one's hand.

We are challenged at every turn: our patience, our tolerance, our ability to listen, to feel, to communicate, to observe, to respond, to withold, to move forward, to be still. At times the world calls for our action, at times it yearns of rou lack of action, our ability to sit there and do nothing. But even inaction takes courage, wisdom, and above all, compassion.

What the world needs more than anything is bodhisattvas, active servants of peace, “clothed,” as Longchenpa said, “in the armor of perseverance,” dedicated to their bodhisattva vision and to the spreading of wisdom into all reaches of our experience. We need bodhisattva lawyers, bodhisattva artists and politicians, bodhisattva doctors and economists, bodhisattva teachers and scientists, bodhisattva technicians and engineers, bodhisattvas everywhere, working consciously as channels of compassion and wisdom at every level and in every situation of society; working to transform their minds and actions and those of others, working tirelessly in the certain knowledge of the support of the buddhas and enlightened beings for the preservation of our world and for a more merciful future.----Sogyal Rinpoche

Back in the Saddle

Well, here we are, back in work mode, my personal life having stabilized to some extent, the grieving process for my canine soul-mate continuing. My back pain is still with me, although somewhat diminished after a spinal injection three weeks ago, and now my step-father seems to have an apparently malignant mass in his pancreas, necessitating major surgery and other treatment. If only I could take a leave of absence to simply live my life, but no such luck.

At the office, we have the usual goings-on:

A patient dying of advanced cancer and AIDS took it upon himself (with help from his brother) to destroy a $3000 IV home infusion pump which they said "broke" on its own. They were apparently attempting to figure out how to extract the morphine from the pump to inject it all at once intravenously for a major dose of relaxation. Probably a good thing they failed----it most likely would have killed them both.

Patients struggle with psychiatric illness and the lack of services in our area. So many psychiatric outpatient facilities work on a "fee-for-service" basis, hence our patients---who tend to not show for appointments alot---get taken off lists and moved to the bottom, often losing all hope of treatment in town. That leaves us with dozens of the most fragile patients without proper psychiatric treatment. This fee-for-service idea has got to go. That's one of the things our program has going for it---we are paid an annual amount to care for our hundreds of patients and then we figure out how to care for them best. We don't bill for each contact, thus we are not desperate for visits, nor do we avoid visits which might take a number of hours to accomplish. We are relatively free from that economic disincentive to provide quality care.

That said, I struggle under a caseload of 83. How to keep that many people in my consciousness? How to remember what I need to follow up on each day? How to not lose the threads that need to be connected again in the fabric of care? I hobble along, sometimes stumbling, sometimes sprinting, sometimes collapsing from exhaustion.

A number of my patients have broken bones this year. One was hit by a car while crossing the street. Another patient with Multiple Sclerosis fell against the kitchen table and fractured her humerus. Someone else tripped on a wet floor and broke her ankle. I don't usually have this effect on people, but my patients break their bones at an alarming rate. Do they need pedestrian airbags?

Still others seem to develop multiple chronic injuries from out of the blue (sort of like I manifested a spinal cyst). This one has several meniscal tears in her knee. Another has herniated discs. Still another has a torn rotator cuff. These bodies sure take a beating.

My mind is spinning with scenarios, issues to deal with, patients to follow up on, people to call, referrals to make, treatments to assess. It seems that when you take 83 chronically ill people, put them all together in a big box, add poverty and stir generously, you get a recipe for multiple comorbidities needing a comprehensive and global approach to care managment. That's where I come in, and it is, I must confess, not an easy row to hoe.

But tomorrow's another day. And I'll be there.

Change of Shift Again

Please visit the newest edition of Change of Shift, a nursing blog carnival, here. Thanks for stopping in.

Hello Dear Readers

Hello dear Readers. Sadness has quite a grip at this moment. Work offers the distraction of tasks and other people to care for, but home brings the reality of loss and change that death delivers. Please see Latter Day Sparks for other writings, and understand that this blog will be more of what it used to be when this grieving process is not so new.

Thanks, and please return as often as you like. I shan't be in this state for too long.....

Sparkey's Passage From This Earth

Dear Friends and Loved Ones,

Yesterday, September 2nd, 2006, at 2:20pm, Sparkey left his body and this physical existence in the most peaceful way imaginable. The screened-in porch was a sacred space---a shrine created lovingly by Mary---of photos, candles, objects of devotion, and mementos of Sparkey's sweet and noble life. The party lights were lit all night on Friday, the porch glowing, the cool breezes cleansing the space. Mary smudged the house with sage, and also smudged Sparkey several times briefly.

The vet arrived at 1:30, Tina already in the care of a neighbor, her shades drawn so that Tina would not see the vet's van and be traumatized by the sight of it. Rene and I dug the grave in the morning, the area protected from rain with a brown tarp suspended from surrounding trees, that piece of earth blessed and consecrated by the three of us before beginning our task. We had at the ready an urn of our dear friend Woody's ashes, several of Rene's wisdom teeth, three sticks representing the three of us, a bone unearthed while digging the grave (most likely buried by Tina some long-forgotten afternoon), and a sage smudge stick. We had chosen a lovely cotton tapestry of aqua and earth tones and Native American design in which to wrap his body. This fabric had covered a favorite chair in our house where he had lived as a puppy. The grave was round like a womb and three feet deep.

The compassionate doctor sat with us on the floor of the porch as we connected with Sparkey. He had ensconced himself in the very spot where we had planned for his transition to occur, and we only had to shift him slightly so that we could all kneel on the foam mattress at his head. The vet sat at his feet and explained that she would inject a strong sedative into his buttock muscle so that he would become very drowsy and probably fall asleep. Only when he was completely relaxed would she access a vein on his hind leg and insert a needle and small catheter which would allow for the overdose of anesthesia which would actually stop his heart. Following the first injection, we all brought our faces very close to his, looking in his eyes as they became heavier, telling him sweet things, what dogs to look for in his new home, and how grateful we were to him for his service and loyal companionship. Even after more than a minute, he still was not completely drowsy, his head moving slowly from right to left, approximately four inches above the bed. I had the image that he was already slightly above his body, trying to detach, and was looking from left to right to take in a final image of the three of us and the scene in which he was the central player.

Following a whispered conversation between myself and the vet, she injected another dose of sedative and he slowly lowered his head to the soft mattress covered with a maroon flannel sheet, closing his eyes for the last time. Crying, we all said goodbye and urged him to float on, and we each placed a hand on his heart which was still beating slowly. The doctor then began the infusion of anesthesia into the needle placed in a vein of his right hind leg. A small patch of hair had been shaved and that hair was stowed in a small wooden urn kept on hand for that purpose. With our hands we could feel his heart slow and then peacefully cease its motion. He did not take a final deep breath as is sometimes experienced. His heart simply stopped beating and his respirations halted. Beautifully, a single tear formed at the outer corner of his left eye, fully visible to the three of us, and we wept as this lone tear increased in size and then streaked down his lovely orange face. The muscles around his nose were the only ones which twitched for a minute or so, almost as if he was getting a last scent of this earth which he so loved.

Taking her leave, the very sensitive vet exited quietly, and we were left to tend Sparkey's beloved body in private. Rene brushed him down, and gathered some of the fur. We also cut some of his hairs from several places with a pair scissors. I fetched Tina from our neighbors and brought her to see her brother's body. Wrapping him in the chosen fabric, we carried him to the grave, lowered him in gently, each took a turn kissing his head, and tucked him in, his spine gracefully curved, his front paws below his chin. The three sticks, Rene's wisdom teeth, and the bone were placed in the grave, and some of Woody's ashes were rubbed into the fur over Sparkey's heart by each of us in turn. Finally, covering his head and face, we then took turns putting handfuls of dirt over his shrouded body. One of the most difficult things I have ever done was gently place a shovelful of dirt over what I knew to be Sparkey's head. It was at that moment that I knew he was gone forever and would never return. Rene assisted me in completing this task of closure, and we then had our private family time around the grave, Tina at our side.

His body is now resting in the earth, his soul free to run with his friends old and new, and we give thanks for this loyal companion who loved us so unconditionally. His grave is now our sanctuary, and we will tend it with as much love as he tended our home and lives.

Sparkey's body is dead. Long live Sparkey's spirit.

Namaste.