Throwback Thursday: The ER and the Stroke

When I quit the day job, nine years ago now, I inquired to volunteer at a local hospital, and was processed through a formal application and selection drill: application with references and background check; tuberculosis test and booster shots; orientation that included a grand tour of the byzantine hospital bowels; attend specialty departmental training; get a branded work shirt and a photo badge, a job post, and a schedule. I was assigned to the Emergency Room.

There were two main entrances to the emergency room, out back, where the emergency vehicles (ambulances, fire engines, police cars) enjoyed a red carpet treatment, and out front, which was open to the general public, patients arriving alone, with a partner, in small groups, by car, cab, city bus, bicycle, or on foot, in all manner of conditions, inside and out, physical and mental and emotional, in every kind of weather. I worked the out front entrance.

At first, I was given three main duties or responsibilities: I maintained a fresh supply of wheelchairs at the entrance and greeted patients who needed one at the sidewalk or curb, wheeling them inside and up to the reception desk; I walked around the waiting room tidying up and cleaning as necessary; and I handed out bottled water, blankets and pillows, and ice packs. Occasionally, I ran errands out of the ER, collecting wheelchairs that had wandered off like shopping carts from a grocery, or picking up something special for someone from the gift shop or cafeteria, or showing some lost visitor the way to the elevator that would get them to the floor they wanted. On my way back to the ER, I might slip into the chapel to ensure there was at least one candle still burning.

Usually, I was the only volunteer on a given shift, or a couple of shifts might overlap, and another volunteer and I might bond and compare impressions. I had agreed to work any day or time, which meant I got some evening and weekend shifts, when the main hospital felt sort of like a ballpark when there isn’t a game going on, but the ER concession was busier than ever.

One of the shift supervisors was keen on keeping everyone looking busy. Usually, everyone was busy, but Big Nurse, I’ll call her, though she was a tiny lead wire, frowned on any posture that might suggest idleness or shiftlessness. At orientation, the topic of blood was introduced. Not for the squeamish was the ER. If you had a problem with blood, they could find you a job in an office somewhere, safe from the oozes and crusts. Still, volunteers should all avoid blood contact, and in any case, would not be required to touch anything, well, bloody. One evening, I wheeled a patient holding a large rag under her arm into the waiting room. She was quickly admitted, but we had stopped a few moments outside the ER. On my way back with the wheelchair, I noticed some blood pooled on the tile floor. I told Big Nurse about it. Well, she said, clean it up, and she handed me a pair of gloves, a spray bottle of cleaning solvent, and some towels. Throw the towels and gloves into the toxic bin when you’re through, she said.

I sprayed and scrubbed the floor clean of the blood and properly disposed of the tainted tools of the trade. Returning to my station, I looked back at my work, and there gleaming in the unfriendly light of the lobby was a spot in the tile floor that looked as clean as the holy grail. I had either washed clean through the floor finish, or the rest of the floor had not been cleaned in some time.

You might think a visit to the ER a rare occurrence for most individuals, but there were a few regulars everyone seemed to know by name, and one, in particular, was adept at making a scene. The night I met him, he was being treated like the boy who cried wolf one too many times, and he was not being admitted. I was asked to help him out of the lobby. I asked him if he’d like a wheelchair. No, he said, grabbing and wrapping my arm in his, spreading an amazing swath of sweat across my bare arm. Just hold me up and help me walk, he said, assuming now the most stoic of attitudes. After helping him out, I went to the restroom and scrubbed my arms as if I was heading in to surgery, unsure if the ER was my calling.

The reception desk work station separated the waiting room from the general emergency room complex. After I’d been a few times on her shift, and possibly after seeing I could handle a bit of blood and sweat, Big Nurse began to give me jobs inside the ER. You entered the actual ER through a large set of automatic doors, the opening big enough to wheel a chair or bed through. Immediately inside the ER were smaller, private hospital-like rooms where nurses and doctors completed patient triage, fixed small complaints, prescribed, or ordered x-rays or other tests, admitted patients or sent them home. Down the wide hall and around the corner from the private rooms, a large, well-lit theatre-like area was rigged with gurneys, nurse stations, and assorted medical equipment. It might have been some back stage of a movie studio lot. This is where the patients who arrived in ambulances were admitted and worked on by shapes in green scrubs wearing masks and plastic gloves.

My new jobs inside the ER proper included remaking beds, tossing used pillow cases into the laundry and fitting on new ones, tidying the exam rooms, emptying trash cans, replenishing supplies, including gloves and towels and tissues. I came and went purposefully, mostly ignored, everyone busy. Back in the waiting room, a couple of children were playing a game of running around in circles. Big Nurse told me to gather them up, take them to the back where there was a kid’s play area, and read them a story or something. She said this with such optimism and confidence you might have thought I had included a stint with Mr. Rogers in his wonderful neighborhood on my resume.

As a volunteer, I had a prepared, approved script should I get any questions from people in the waiting room. I am a volunteer, but I know you have not been forgotten. Sometimes, I would walk to the work station and look at the check-in chart, returning confidently to the waiting patient, assuring them they were still in line. Still, there would be questions I could not have answered if I wanted to: why am I here; why is this happening to me; what’s taking so long; I was here before them; how much longer? I’m going outside for a cigarette – will you come and get me if they call my name? They don’t call it a waiting room for nothing. I started bringing some supplies from home: crayons and coloring books for the children; old New Yorker and Rolling Stone magazines; a couple of used Louis Untermeyer poetry anthologies; a couple of decks of playing cards. The supply had a way of getting used up; things disappeared.

Big Nurse handed me a clip board and told me to call the patient’s name and escort them into an exam room in the ER. I walked out into the waiting room a few steps and called a name, ending it with a hopeful question mark: Joe?

Occasionally, I was invited by a patient to sit and talk, which meant to listen to what had happened. Sometimes, things slowed down, and I walked around the waiting room collecting magazines, picking up empty bottles, tossing used ice packs. The emergency room is open 24 hours a day, seven days a week, all year long. At home, I got busy doing some other things. I missed a week in the ER, then another. And at some point, I realized I probably wasn’t going back. I wasn’t going to be one of those volunteers who had logged in a record number of hours for the year and had their name recognized on a display board in the lobby.

Instead, as these things happen, one Saturday afternoon, I found myself waiting in the waiting room of the ER. Susan had driven me down. Apparently, I was having a stroke. I don’t remember any volunteers. We waited a long time. I felt better. I told Susan I was going to tell them I was going home. They checked their log. Why are you here, again? I tried to explain again what had happened. But I seemed ok now. Well, you’re here. You should talk to someone. We’ll get you right in. And they did. And I was admitted and stayed a week. About a year later, I wrote a little piece about the experience the Oregonian published, which you can read here.

For those who might think of the world as a waiting room, find someone who appears to be waiting, and offer them something to help with the wait.

Plato was a Neuroscientist, too; or, Plato’s Purple Haze

A new Oliver Sacks book is out, The Mind’s Eye. We are kicked in the eye with metaphor, philosophy, and dichotomy, and we have not even opened the book yet: metaphor because Sacks is talking about the brain, for the mind, as Jonah Lehrer put it, “is really just a piece of meat” (Buckminster Fuller defined the mind as the capability to leverage ideas from single case experiences – see Operating Manual for Spaceship Earth); philosophy and dichotomy because to speak of the mind as an idea distinct from the brain is to cross into Plato territory (a very large country of philosopher states).

We came across Sacks’s new book in the April Harper’s Magazine, in a review by Israel Rosenfield, “Oliver Sacks and the plasticity of perception.” The brain is on the move again.

We ordered The Mind’s Eye; meantime, what does Rosenfield have to say about it? Rosenfield makes this claim: “There is a simple fact about evolution that, although rarely mentioned, is very revealing: plants don’t have brains.” (Of course, why mention the obvious, a claim about which there is no disagreement?) Yet here’s his explanation for why plants don’t have brains: “Plants don’t have brains because they don’t need them; they don’t move from place to place.” In grade school we called this moving from place to place “locomotion.” The classic example is the amoeba, but do amoebas have brains? We understand that plants don’t have the same locomotion that animals do, but we question Rosenfield’s claim that plants don’t move from place to place, because plants do move from place to place. They travel underground and in the wind, float down rivers and out to sea, appear in the most unlikely places, out of cracks in the hot summer asphalt. In fact, as Michael Pollan has suggested (The Botany of Desire, 2002), plants manipulate animals: we taxi them around, ferry them, fly them to the moon. Plants may not have brains, or locomotion, but they do get around.

Rosenfield says that brains “create something that is not there; and in doing so they help us to make sense of our environments.” To illustrate, he uses the phenomenon of color. According to Rosenfield, there is no color outside of the brain: “There are no colors in nature,” he says. (Tell that to Van Gogh, whose paintings reveal the brush of a butterfly and the heart of a hummingbird.) Nature, without a brain to perceive it, is like Jimi Hendrix’s “Purple Haze”: “If we were aware of our ‘real’ visual worlds,” Rosenfield says, “we would see constantly changing images of dirty gray, making it difficult for us to recognize forms.” But Zoe, our cat, has no problem recognizing forms. Then again, she does act like she’s on Purple Haze most of the time. In any case, the mention of separate realities brings to mind Plato as well as Purple Haze. Any mention of forms brings us back to Plato. We might also work in Carlos Castaneda’s A Separate Reality. Is there something outside the brain? Is there something inside the brain? What does it look like when the brain is asleep, or astroke?

But it’s a sunny morning in Portland, the first in some time, the sky a solid blue, fronting the promise of a solid gold weekend. Both our brain and mind seem to agree that we should get out and into this sun. Zoe’s already out there, chasing the forms around the Salsa Garden. Ah, Bartleby; Ah, locomotion!

In Twosome Twiminds: News from the Stroke Club – “Who Are We?”

During our stroke, we picked up the Takemine to test our left hand, self-diagnosing our condition. We noticed our left hand with interest; it formed the shape of the chord we had asked for, but not on the frets and strings we wanted. The result was discord, the guitar sounding badly out of tune. We moved to the Telecaster. The sound was distorted, the guitar either badly out of tune, the amplifier’s speaker blown, or our hand forming some new nonsense chord. Yet, “It sounds fine,” Susan said. “It sounds like it always does.”

In Finnegans Wake, Joyce recreates the experience of a stroke: “…and now, forsooth, you have become of twosome twiminds…” (188).

From 12-1-09 Open Culture: “Jill Bolte Taylor’s ‘Stroke of Insight’ talk reaches the top of many lists. What happens when a neuroanatomist experiences a massive stroke and feels all the brain functions she has studied (speech, movement, understanding, etc) suddenly start to slip away? And how do these losses fundamentally change who we are? You’ll find out in a crisp (and at times emotional) 18 minutes and 40 seconds. You can also read her book that elaborates on her life-altering experience. See My Stroke of Insight: A Brain Scientist’s Personal Journey.”

Join the Stoke Club by finding a quiet 20 minutes to watch Taylor’s talk on  video.

Precursor to Garrison Keillor

Imagine my surprise when Susan hands me this morning’s Oregonian, nonchalantly telling me Garrison Keillor has plagiarized my stroke article. As it turns out, it’s just another example of great writers thinking alike, or older folks sharing experiences – I guess; as I said, my ER doctor told me “we see them all the time.”

My article ran in the Oregonian’s Aug. 29th print edition (it ran the day before on the Oregonian web site), and Garrison had his stroke on Labor Day, Sept. 7. His article ran in today’s Salon, and is of course picked up by any number of papers through syndication, including today’s, Sept. 16th, Oregonian (B7).

In any case, I assured Susan that while some writers will take risks to get stories, I don’t think Garrison had a stroke just to write an article. I know I didn’t.

I’m glad to hear that Garrison is doing well. I enjoyed his article, and of course agree with his conclusion – “We are all in the same boat….”

Health Care: Bringing It All Back Home

The Oregonian CupMy health care piece, “An object lesson in health and happiness,” appeared in the Saturday, August 29, 2009 print edition of The Oregonian (p. B5). (Click to see on-line version.)

Seen here: Oregonian coffee cup on Saturday’s paper, and photo of Susan on the Big Sur River, circa 1969.