excerpt from the book-length poem

*AWAKE, ALERT, ORIENTED

 

 

 

 

 

 

a poetry documentary of

Rhode Island Hospital

(RIH)

Medical Intensive Care Unit

(MICU)

 

 

 

 

 

 

Get to a punch line.  Try to understand what’s relevant.  It doesn’t matter if she’s unemployed, it matters what’s the shape of the bacteria.  The shape of the bacteria might tell us the source of infection. 

 

 

 

 

 

 

 

 

 

 

 

 

Figure out what you don’t know and try to get to know about that.  Figure out what you can do without knowing the stuff you don’t know about without making things worse.  It’s OK to write things down, OK? Keep your notes with you, OK?                                       OK.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MICU rounds, AM

15 June 2009

 

PATIENT #3—

 

“Ms. Kendra Ness, 32 years old . . .

“two weeks in the MICU as of 15 June 2009—”

“Who’s the nurse?”

                             “Abby.”

                                                            “—Call Abby.”

 

“—heart rate came down to low one-hundreds from one-thirty,

                             “young, stable—

                                                            “she’s young, but she’s stable—

“pain gone, has nausea, vomiting.  She lives at home, with her mom and her three kids—”

 

“Are the three kids hers?

“Maybe they’re her mom’s?”

 

“Non-smoker, non-IV-drug user, confessed occasional alcohol use, doesn’t have a primary care physician, not taking any meds—”

                                                        

                                                                    “Sounds like everything leads to vomiting.”

 

Sounds, like everything, lead to vomiting.

 

“Comfortable otherwise.  Her chest exam is clear, she’s making urine, she’s able to pee in a urinal—”

—pause—

“HA!”

“She’s able to pee in a bedpan!”

—pause—

                                    “HA!HA!HA!— ”

 

“Hemoglobin 12, platelets down to 130—”

                                                                    “—It’s usually: give cipro, obtain urine culture—”

“no hydronephrosis—”

 

“See! This happened the last time!

 

“What are you giving her for nausea?                                       Abby, what do you think?”

 

“Well, before—when he said her pain’s gone?—Well, she rated her pain 10 out of 10.”

“What do you rate her pain?” 

“It’s in her groin—”

“No, but what do you—”

“it’s . . .          legitimate. ”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MICU rounds, PM

patient visit—Ms. Kendra Ness

18 June 2009

 

Kendra looks like a puddle.

 

“They look like puddles because they are puddles.”

 

“Her skin has become the container for her bodily fluids—instead of her vessels.”  Her belly is swollen and round.

 

Kendra’s face is swollen and round, her right cheek deflates on her pillow.  Eyes closed, eyelids crimson.  She’s not looking anywhere—eyes closed in to all that fluid.

 

 

In the MICU, edema often occurs in patients who are being treated with large volumes of IV fluid.  The sodium in the fluid disrupts the usual pressure dynamics between the cardiovascular system and the surrounding tissues. The sodium in the IV fluid moves out of the blood vessels and into the space between blood vessels (called interstitial space). Water molecules then also move out of the blood vessels and into the interstitial space, so that the proportion of water to sodium inside the blood vessels comes to equal that proportion outside the blood vessels.

 

Water may also move into the interstitial space if the plasma proteins in the blood are reduced—for example, from malnutrition.  Usually, such compounds as plasma proteins pull fluid back into the capillaries, providing counter-balance osmotic pressure across the capillary walls.  When these compounds are absent, water may move into the interstitial space.

 

As water builds up in the interstitial space, the tissues become puffy, and people swell within their skins.  “They are puddles.” This is called edema. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Get to a punch line.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kendra died before her doctors discerned a source of infection.

 

 

 

 

 

 

 

 

 

 

Gauze covered her skin ulcers—purple and yellow bulls-eyes below her navel.

 

 

 

 

 

 

 

 

 

In the waiting room, Kendra’s friend arrives and hugs Kendra’s sister.  “You know, when she had the kidney transplant eleven years ago, 32 seemed far away, like an advanced age. Now[1]—32?”

 

Tonight, morphine in Kendra’s blood, 32 seems as incomplete an age as any.  “It seems like 8 years old.”  It’s like 12 years old.  It’s like other ages when Kendra was living and was living—like 3 hours and 3 months, 14 months, 3, 4, 9, 8 years

11, 15, 16 ½,

18, 22, 24, 27,

28, 29, 30, 31.

 

Before the morphine, pain—

Because of pain, morphine—

Pain, Age—

Time, Opiates—

Masses—clotted-blood-&-pus masses, breaking—

       bursting through thin skin—

 

 

 

 

 

 

 

 

 

 

 

 

 

If “Kendra” is a Polish name, it means “long-haired woman.”  If “Kendra” is an Anglo-Saxon name, it means “understanding” or “knowledge.”   If “Kendra” is an English name, it combines the names Ken and Sandra, or Ken and Andrea.  “Kendra” may be a variation of the name Kenda.  “Kenda” may be English for “water baby” (like Moses?), or it may be Dakota for “magical power.” “Kendra” could be a female form of “Kendrick,” which may originate from the Welsh for “greatest champion” (Cynwrig) or the Anglo-Saxon for “family ruler” (Cyneric). “Kendra” may refer to a beautiful woman, a goddess-like woman. “Kendra” may be a Curonian word meaning “cedar.”  The Latvian for “cedar” is “ciedra.” 

 

Curonian is a language with old and new forms, spoken in the Curonian Spit, by people who also speak Latvian. The Curonian Spit is an elongated sand dune peninsula, 98 km long and .4-4 km wide. It connects Lesnoj, in Russia, with Klaipeda, in Lithuania, like a hair anchored in saliva would connect the ear to the mouth and frame the cheek. The Curonian Spit frames a lagoon, The Curonian Lagoon. The Curonian Spit is a precarious formation.  It has been threatened by winds and waves since prehistory.  Its survives, though, through ceaseless human efforts.[2]

 

A nurse cares for Kendra and one other patient.  An attending physician, five residents, one fellow and a transplant surgeon care for her, as well.  Two sisters, one mother, three nephews, a childhood friend.  Some of the physicians examine her personally and some discuss, think, and consult regarding her case. I am here writing down her story, and here you are reading it.

 

The Curonian Spit survives the winds and waves because ceaseless human efforts combat erosion. For example, continuing stabilization and reforestation projects combat erosion.

 

“Everything leads to vomiting,” says one of Kendra’s doctors. “We don’t know the source of infection,” says another. Ceaseless human efforts swirl around her without touching the source, like a whirlpool with a center that is merely imaginary, just effort near a dark opening.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It took Kendra longer to die than her physician had predicted it would take her, by about three hours.  In the course of three hours, her mother and sisters encircled her, image of goslings reaching open mouths up to a mother bird, but inverted: the separate one below, her mouth slack and empty.

 

Kendra’s mother sang a lullaby into her right ear. Kendra’s sister caressed her temple with the back of her right hand—tan and clean.

 

The third sister, flown up from Florida that afternoon, smiled and talked about her son.  She watched her mother and sisters and narrowed her brow. “Kendra really loved Benjamin,” she said.  There, now I’m thinking about Kendra now.[3]