Notebook: Angels

Editor’s note: “Angels” is an excerpt from a short story about family caregiving that I’m writing for my book, Rest. I began it this fall in Eson Kim‘s Fiction I class at GrubStreet Creative Writing Center in Boston. In this excerpt, we meet Arnold Davies, who is just waking up from surgery, and his wife Mim. — MAB

Chanson de la plus haute tour (II) by Airair, 2007.

EYES FLUTTERING OPEN, ARNOLD IS ON THE DIM EDGE OF FREAKING OUT.

On a Friday afternoon just before Christmas, Arnold wakes up from cardiac bypass surgery, gasping, in one of those high-tech hospital cribs with pushbutton-this and bellringing-that.

Eyes fluttering open, he’s on the dim edge of freaking out, which God knows is a perfectly reasonable response to waking up on a ventilator with a massive bandage on his chest, a tube down his nose, an IV in his hand, and a raging thirst. The first thing Arnold tries to do is swallow – a gulp of panic – but he can’t do it because of the ventilator tube in his throat.

Aagh, he thinks. Aagh! His mind generates the kind of dazed roar that precedes distinct thought. He’s in pain and he can’t swallow, can’t call out for help, and can’t even turn his head. There’s a whole lot of beeping going on. In his head he thinks something, perhaps Oh God, or Mim? Mim?

“Mr. Davies, I see you’re awake.” A woman with an angelic cloud of hair has appeared at his bedside. “You’re in cardiac surgery intensive care and you are doing just fine,” the angel says. “Your surgery is over.” Arnold blinks. The angel smiles a practiced smile.

“Mr. Davies, can you squeeze my hand?” asks the angel. “Good. Wiggle your toes? Terrific. Ok now, I want you to follow my finger with your eyes. Follow it back again. Good. Now, are you in pain? Nod if you’re in pain.”

Arnold nods. His left hand quivers and tries to raise itself, but it’s tied down. Tears escape Arnold’s eyes and slide down his cheeks; he’s mortified. His nose drips.

 Head of the Virgin in Three-Quarter View Facing Right by Leonardo da Vinci

“WE’RE GOING TO GIVE YOU SOMETHING FOR PAIN.”

“We’re going to give you something for pain,” the angel announces. There’s an indeterminate flurry of activity. Someone wipes his cheeks and blots the drips coming out of his nose. “You’re on a ventilator,” the angel says, “so you won’t be able to talk. You’re doing just fine.” Seconds later, he feels blessed relief steal past his ribs into the core of his being. He slips back into the deep.

In the ICU, time passes. Techs, nurses, docs, visitors, kitchen staff swirl down the hall past Arnold’s room. From time to time, someone disturbs his sleep.

Then: “Arnold, honey, it’s Mim.” Arnold stares up at her face, feels his wife’s hand stroking his hand. Briefly, her hair touches his neck.

Mim, he thinks. Tears slide out of his lids. Mim, I need a drink, he thinks. Her fingers wipe the tears down over the pale surface of his face. Her hand strokes the hair on his head, slides around to touch his cheek.

“Wounds heal from the inside out,” Dr. Binh said to Mim in the waiting room after surgery. “Absolutely at this moment, and at every moment since I made the first incision, your husband’s brain and tissues have been directing billions of cellular procedures aimed at stopping the bleeding and repairing the damage. These cellular repair procedures are programmed in us by DNA. All we need to do is breathe and wait, or, in Arnold’s case, allow the ventilator to breathe. Just be in the moment.”

In this moment, Arnold weighs the pressure of his body on the bed; Mim’s hand on his; electronic sounds; the wedged feeling in his throat. A slow-moving awareness begins to reduce the roar in his head.

Head of a Negro by Peter Paul Rubens

“BREATHE DEEPLY, ARNOLD,” THE NURSE SAYS.

New angel: a man with dark hands and fingers, a Caribbean voice.

“Arnold,” the nurse tells him, “we’re going to remove your ventilator tube and give you a try at breathing on your own.” It feels like somebody’s pulling a hose out of his throat, fast.

“Breathe deeply, Arnold,” the nurse says. “That’s right, breathe in and then breathe out again.” The machines change their pattern of beeps. Arnold breathes. His throat burns when he swallows but it feels so good to be able to swallow, even though the thirst consumes him. Someone feeds him ice chips; a blessing.

Now that the breathing tube is out, Mim has been allowed back into Arnold’s room. She sets her carryall bag on the floor and sighs down into the chair, twitching her thin yellow infection control gown over her clothes. Her hands smell of disinfectant gel.

Woman Embroidering by August Macke, German, 1909.

DEAR ARNOLD, MIM THINKS, DO YOU REMEMBER THAT SONG ON THE RADIO WHEN WE MET?

Dear Arnold, Mim thinks, Do you remember that song on the radio when we met? She remembers their wedding ceremony at her grandmother’s church in Chicago, her triumphant smile as she processed down the aisle towards Arnold on a gust of bridal pride.

“Can I have some water?” Arnold has wakened.

“Let’s sit you up,” says the nurse. “Hold this to your chest.” He hands Arnold a heart-shaped cough pillow and presses buttons. The head of the bed raises a tad. Oh, God! Something clotted surges downward in Arnold’s chest.

“You’re ok, Arnold,” the nurse tells him. “It’s ok, your chest tube will get rid of the fluids. You’re safe.” He turns to Mim: “You can give him ice chips, but just a couple at a time.”

“Of course,” says Mim. She finds herself breathing in unison with Arnold, as if they’re engaged in some joint venture that requires the highest levels of corporeal coordination. Hearts and lungs have never felt more precious, nor angels’ voices nearer.

— Mary Ann Barton

Image credits (from the top): Chanson de la plus haute tour (II) by Airair, 2007, via Wikimedia. * Head of the Virgin in Three-Quarter View Facing Right by Leonardo da Vinci, Italian, 1508-1512, via Metropolitan Museum of Art, Harris Brisbane Dick Fund, 1951 (51.90). Head of a Negro by Peter Paul Rubens, Flemish, ca. 1620, via Wikimedia. * Woman Embroidering by August Macke, German, 1909, via Wikimedia.

Portrait of a Lady as the Magdalen by Master of the Female Half-Lengths

Dear Emma: Snappy Letters to My Alter Ego

Portrait of a Lady as the Magdalen by Master of the Female Half-LengthsEditor’s note: From time to time I share my writing process with readers of the Joyous Paradox blog. Today’s post is about my literary character Emma Davies, who began showing up in my notebook when my son Edward was in elementary school. (He’s now 35.)

“Who are you, Emma Davies?” I asked her, when her name first slipped into my consciousness all those years ago. “Why do you feel so familiar?”

Back then, all I could see of Emma’s life was the title of a story, “Emma Visits the Wise Woman.” It’s a story I hope to write one day. In the meantime, I often write to Emma in my notebook. Here’s a recent sample, edited and extended for clarity. Hope you like it. — Mary Ann Barton

Girl Writing by Franz NölkenSunday, June 7, 2015

Dear Emma,

It’s crowded and noisy here in the First Parish parlor. Small boys bounce up and down on the antique sofa. They hop off and drop to the oriental rug on the floor.

“Let’s say goodbye to Nana,” says a mother to her son.

“Bye, Nana,” the little boy mumbles.

“Nana can’t hear you,” his mother says. “It’s very loud in here.”

“Nana!” he yells, tugging his grandmother’s sleeve. “Goodbye, Nana!”

I’m writing this letter to you while I wait for Steve to finish chatting with the ministerial intern. I’d like to go somewhere quiet and write my author bio to share with Susan and Stephanie when we meet at Dumpling Daughter tomorrow to talk about book marketing.

Essayist Mary Ann Barton has taken full advantage of the opportunities life offers for failure and rebirth. Working as a rare coin dealer, arts agency desk-jockey, lobbyist, textbook proofreader, and library fundraiser, she found her niche in her fifties as a certified nursing assistant and companion to elders. Her work in progress, a trilogy of self-help books called Rest, Renewal, and Repose, will help family caregivers of all ages get back to sleep when worrying about a loved one who is very old, very young, or facing serious illness. She blogs about caring for ourselves as we care for others at JoyousParadox.com.

Portrait of Lola Braz by Zinaida SerebriakovaHere’s what I write about, Emma: How we live with others. How we live with ourselves. I’m writing a peach of a book for family caregivers. I want you to pick up Rest in the middle of the night when your old dad or your tiny child is safe in bed. Find tips and techniques for caring for your body, mind, and soul. Read a poem about a garden, a grocery list, or a grandmother who plays the cello. Love a painting by Philippe Mercier. Write in your journal. Dance as you cook dinner. Stretch your arms wide with an Octaband.

Really, Emma, caring for a loved one can be full of surprises. As Facebook would say, it’s complicated.

For some of us, there’s so much accumulated hurt and resentment that the free flow of love and concern is jammed up behind a Hoover Dam of bad memories.

For some of us, love flows so freely that we can’t let ourselves even dip a toe in the reality that we might lose our dearest on earth.

Writing a Letter by Kusakabe KimbeiFor all of us, there are images, real or imagined. I look at the shifting family groups in the church parlor — women and men and grandparents and babies and five-year-olds and young girls who might be anything from ten to 17 — and see them as photographs in an album.

Maybe the photos have a matte finish like the slightly pebbled surface of an oldfashioned school portrait. Mrs. Ansell’s Second Grade. That First Vacation at Lake Sunapee.  The Balloon Flight in Southern France. Our Last Visit with Grandma Hyde.

Maybe one day I’ll see a photo or a painting, Emma, and know that this is your likeness. I can’t wait.

Love no matter what,

Mary Ann

Copy this text to tweet: Caring for a loved one can be full of surprises. As Facebook would say, it’s complicated.  #caregivers

Image credits: Portrait of a Lady as the Magdalen by Master of the Female Half-Lengths, Netherlands (fl. circa 1500–1530), via Wikimedia Commons. Girl Writing by Franz Nölken, German, 1916, via Wikimedia Commons. Portrait of Lola Braz by Zinaida Serebriakova, Russian, 1910, via Wikimedia Commons. Writing Letter by Kusakabe Kimbei, Japanese, before 1933, via Wikimedia Commons.

How To Grieve With Challah Bread by Ellabell Risbridger

“How to Grieve with Challah Bread” struck me as a perfect expression of the complexities of family life. Grief and loss. Rituals and remembrances. New loaves braided and baked and broken at the table. All these are emblems and occasions of belonging to the tribes of our birth. — MAB

Eating With My Fingers

My grandfather is dead: I do not know how to grieve. So I make bread.

In the Bible they call bread the staff of life (my grandfather might have liked this: he liked religion), but really it’s the staff of grief. And rage, and guilt. I do not know how to grieve. I am twenty-two: my grandparents had children young, and I thought they would all die old. Older. I do not know how to grieve. I do not know how to grieve my grandfather’s passing, because I barely knew my grandfather. I tried to tell someone “he was like this-” and I came up short: who was my grandfather?

dough challah

He let me eat apple pie for breakfast. He was my father’s father. He was bald. He liked to garden. He was a teacher, and some kind of occasional preacher. He came from a village called something like Jacksondale, which…

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Safe Space Radio

Guilt When a Parent Dies

Editor’s note: How does a single voice manage to share such rich and heart-grained stories? Listen here, dear readers, to two plainspoken men as they talk about guilt when a parent dies with Dr. Anne Hallward of the Maine radio program, Safe Space Radio. — MAB

We continue our series on hidden feelings this week with two stories about guilt, the kind we feel when we believe we didn’t do enough at the end of a parent’s life.  We’ll hear from people who were troubled by the way they failed to show up for their parents, and discuss the process of finding relief from that guilt. — Dr. Anne Hallward, Safe Space Radio

http://safespaceradio.com/2015/04/guilt-when-a-parent-dies/

Copyright © 2015 Safe Space Radio, All rights reserved. Posted with permission of the author.

Jesse and the Typewriter Shop

Editor’s note: I took typing one summer at Schurz High School in Chicago and still remember the class fondly. Mary Maldonado and I used to walk home from class together in the suffocating heat of a Midwestern city. Sometimes I’d walk her all the way to her house, hoping to catch a glimpse of her older brother, Paul, who played bassoon in my high school band. I still have my mother’s pale green Olivetti typewriter that she lugged around in her post-retirement travels from Chicago to Kentucky to Montana to New Jersey to New Hampshire to Massachusetts.  Here, reblogged from The Casual Optimist, is a touching film about father-and-son typewriter repairmen in Los Angeles. Do you have an old typewriter somewhere in the house? Do you still use it? — MAB

Related to yesterday’s post on Gramercy Typewriter Co. in New York, here’s a short film about U.S. Office Machines, one of the last remaining typewriter repair shops in Los Angeles:

(Thanks Sam!)

Dr. Atul Gawande in Being Mortal, a Frontline documentary on PBS

“Being Mortal” Airs Tonight

“The two big unfixables are aging and dying…you can’t fix those.” — Atul Gawande

Editor’s note: PBS airs a documentary tonight based on Atul Gawande’s book Being Mortal. It promises to be a candid and intimate look at doctors and families coming to terms with the end of life. This article by Stephanie E. Rogers, MD, appears in the blog Geripal. — MAB, 2/10/2015

The True Art of Medicine: Atul Gawande and The Being Mortal Documentary

by Stephanie E. Rogers, MD @SERogersMD

“The two big unfixables are aging and dying…you can’t fix those,” notes physician-writer Dr. Atul Gawande, in a new documentary based on his recent book Being Mortal. The Frontline documentary airs Tuesday, February 10 on PBS, and explores Gawande’s frustration of not being able to “fix” all of his patients.

The Being Mortal documentary examines how Gawande and other physicians struggle to talk with patients and families about death and dying. He explores his own humble journey with the realization that “medicine fails the people it’s supposed to help” at the end of life. It also provides a powerful, intimate look at families struggling with conversations about the realities of aging and death, and the uncomfortable and difficult time even well-trained physicians have at leading these discussions.

One of the most startling aspects of the documentary is watching physicians participate in these conversations with patients and the behind the scenes look at what their thoughts are regarding these discussions. Even with cancer physicians who have these conversations all the time, it is apparent that they too are struggling to be forthright and eloquent. In fact, this is what makes Gawande a skillful storyteller — he exposes his own vulnerabilities both as a physician trying not to be the bearer of bad news and as a patient’s family member during his father’s inevitable death from a spinal cord tumor.

“Hope is not a plan,” Dr. Gawande argues. “We find from our trials that we are literally inflicting therapies on people that shorten their lives and increase their suffering, due to an inability to come to good decisions.” He notes that people may have other priorities besides living longer and that we should not be waiting until the last week of life to have these discussions with our patients.

As a Geriatrics fellow, I have learned that speaking to patients frankly about aging, dying, and their priorities for the time they have left has been the toughest challenge I’ve encountered yet in my decade of medical training. We physicians tend to be overly optimistic and timid about the truth, partly because it is difficult to tell a patient something they don’t want to hear. We want to instill confidence in our patients and hope with them for a cure or more time.

I now realize that the most worthy challenge– one likely to last my entire career – is to improve my ability to have these conversations. Our decisive goal as physicians is not only to know the most up-to-date scientific studies or treatments, but to be comfortable and capable of communicating truthfully and empathetically to our patients about the realities of life — that we will all age and we will all die. The true challenge is combining all our medical knowledge and skills with the art of communication, to allow our patients to choose how they want to live—all the way to the end. Being Mortal, the Frontline documentary from writer/producer/director Tom Jennings, airs Tuesday, February 10 on PBS and will stream in full online at pbs.org/frontlinehttp://pbs.org/frontline.

Source: Stephanie E. Rogers, MD, “The True Art of Medicine: Atul Gawande and The Being Mortal Documentary,” GeriPal: A  Geriatrics and Palliative Care Blog (blog), February 9, 2015, http://www.geripal.org/2015/02/atul-gawande-being-mortal-documentary.html.

Paintings for a Snowy Day

Tuesday, January 27, 2015

Editor’s Note: I’m at home today, watching the snow fall and looking at paintings of snow scenes in Wikimedia Commons. Why not share these with someone you love? You could use them as prompts for writing, telling stories, or making art with the children — or grownups — in your life. — MAB 

A family watches as snow begins to fallA family watches as snow begins to fall: The First Snow by Adrian Ludwig Richter, German, 19th century, via Wikimedia Commons.

Now snow fills the streetNow snow fills the street: Fiskaregränd (Fishermen Alley) in Stockholm by Axel Axelson, Swedish (1854-1892), no date, via Wikimedia Commons.

Bundle up, my friends!Bundle up, my friends! Artillery Street in Winter by Alf Wallander, Swedish, 1892, via Wikimedia Commons.

Dressing warmly helpsDressing warmly helps: Girl in the Snow by József Rippl-Rónai, Hungarian, 1906, via Wikimedia Commons.

Snow is also for playingSnow is also for playing: Snow Balls by Bertha Boynton Lum, American, ca. 1913, via Wikimedia Commons.

In the woods, foxes step softlyIn the woods, foxes step softly: Common Foxes in the Snow by Friedrich Wilhelm Kuhnert, German, 1893, via Wikimedia Commons.

At the end of the day, let's warm up with hot drinks and a game of cardsAt the end of the day, let’s warm up with hot drinks and a game of cards: Getting Ready for a Game by Carl Larsson, Swedish, 1901, via Wikimedia Commons.

The Swedish National Museum gives us Larsson’s description of Getting Ready for a Game:

“It’s really terrible outdoors. The wind is whistling through the joints of the house and the snow is not snow but sharp needles that get into the corners of one’s eyes… Just the right time for a game of ‘vira’. Here is the tray full of comforting drinks and all the necessaries and Karin is still not finished with the final decorations which include the monastery liqueur which she is taking off the shelf. In the background is the altar itself, the card table that I have arranged myself.”

[This is] Carl Larsson’s own description of his painting, Getting Ready for a Game, in the book entitled Larssons which was published by Bonniers in 1902. The “vira” that Carl Larsson mentioned was an enormously popular card game invented in Sweden sometime in the 19th century.