Thursday
Apr112013

Vessels of Light

Beth Alvarado


 

When Patrick first died, he found himself floating in and out of hospitals, but this floating was not of his own volition. He simply found himself in certain places, observing. Tubing, plastic tubing, catheters, syringes, electricity, water—who would ever have thought these luxuries, he wondered. But they were in Baghdad Medical City where the relatives of the patients were sent out into the streets to buy medical supplies and medicine, however out of date. Only one elevator worked and it smelled, of course, of old sweat. There was no clean water, almost no qualified staff.  Guards armed with machine guns surrounded people as they entered, checking their belongings for weapons, meeting ambulances outside in case the patients were booby-trapped, he supposed. 

Since dying—and he supposed he hadn't been dead all that long for there it was, his body, still lying on the pavement of a parking lot in Tucson—time no longer seemed to have the same speed or relevance. Instead, he had simply been drawn to places where the souls exiting caused a rush of wind. And neither did space seem to abide by the same rules of physics. He could not only hold two places in his mind at once, but he could exist in two, three, four places at once. He hovered, for instance, above his body on the pavement and, simultaneously, above a young girl in Tel Aviv, who had a nail in her brain, but no entry wound. The doctors, looking at the CT scans, were perplexed and decided, based on the nail's position—bomb nails fly head first—that it must have entered through her open mouth. Next to her: a woman with a bone fragment from the bomber lodged in her lung. And outside, Patrick hovered: I feel they are still screaming. This is what he overhead a man saying out on the street, blocks away, near the blackened café. I feel they are still screaming. No, he'd wanted to whisper, they are quiet now. Watching.

 

Around five on his last evening, Patrick had ordered a few pizzas and eaten them with his staff; then he had given a lecture to the residents at the University of Arizona College of Medicine. Afterwards, when he stopped by his office to jot down a few notes on his computer, he noted there was a distinct chill in the air. It meant fall was on the way. After all, it was October, he reminded himself, about time for the air to cool down. He thought about walking with the kids and Denise up into Sabino Canyon. They would do it again this weekend. He'd put the baby in the carrier and they'd go for a long walk.

In the office, he switched on the computer, opened the office fridge and took out a cold slice of pizza. He took a few bites and discarded the rest. Why did it take the computer forever? He rubbed his eyes under his glasses. Some of the residents had looked as tired as he felt. He had wondered, momentarily, if he should warn them: it's not over yet, not even when you have your own practice. If anything, being torn between your work and your life only gets harder. 

Denise would be asleep by now and, of course, so would the kids. He'd seen them that morning when she'd brought them by so she could use the computer. Funny how long ago that morning seemed. Funny how he already missed them. They'd sat together on the floor in his office eating pretzels. He'd been wearing his floppy white hat, had the finger puppets he used with his young patients in the pockets of his scrubs. As soon as he picked the baby up, she'd dug in his pockets to find them. Andrés had insisted on wearing the hat even though it covered his eyes and he had to hold his head all the way back to see from under its brim. Patrick rubbed his eyes again, made his notes. What was it about having children, he wondered, that made time disappear?

 

Certainly had Patrick known he was about to be attacked, he would have held his hands out. Here, he would have said, take the keys. Take the money. Whatever you want, take it. Surely, he would have defended himself, but he hadn't had a clue. He'd just opened the door to his car when he heard someone behind him call out his name. He didn't recognize the man approaching him, but obviously the guy knew him, worked—judging by the scrubs—at an office nearby. Patrick wondered if he needed help. Perhaps his car wouldn't start. Or maybe it was one of the residents and he had a question. Patrick squinted. The parking lot was fairly dark and the lone streetlight shone in his eyes and so, when the guy got close and brought his arm up as if to strike, it was too late. Patrick didn't feel anything at first. The explosion in his chest might have been adrenaline, that heat that starts in your heart and floods up into your head. Still, he fell back against the car door, staggering from the force of the blow. It was hard to breathe. His chest hurt. He was falling, his head hit the pavement in an explosion of light, and then he was on the ground, the guy over him like a nightmare. Patrick heard the sharp gasping. This was when he knew it was serious. He had to do something. He reached out and grabbed at the guy; the arm came down again.  

Or maybe the explosion of light came first. He had just opened the door when he heard footsteps coming up behind him. As he turned to see, there was a blow to the back of his head, hard enough to rock his brain, blind him. He stumbled back. Off balance, falling back, he grasped at the shadow between him and the lone streetlight. He grabbed hair. He was falling. Something sharp was slashing at his shirt. He yelled something, something guttural. He felt a quick stab of panic, a contraction of his heart, of every organ in his body. He hit the ground and heard the air whump out of his chest. That's when he saw the glint of the knife, the guy's arm, up and back. 

Patrick couldn't feel it or, curiously, it didn't feel sharp, like a cut, like he might have imagined. Instead, it felt like a fist in the chest and then he realized that maybe the first whump was not air exiting but the first thrust of the knife. Even then, his mind was a doctor's. He was trying to assess the damage. How close to the aorta, for instance.   That gurgling. His lungs? Then he tasted blood, then he couldn't get a breath. Adrenaline rush of panic, yellow, blinding. 

Exit the body. Something, not voice, not mind, not wind said exit the body and he had. Was the tether of his spirit to his body that tenuous? His will to live, that weak? Or was his mind simply detaching due to trauma? A natural reaction to extreme stress? This white light, simply neurons firing.

 

There was no one to staunch Patrick's blood—he could see this—no one to help him. And even had there been someone, he was already beyond help, he knew. He observed the emptiness of the lot. No one. Not even in the shadows. There was a body on the pavement and it was his. He needed to go to Denise. He needed to see his children. He needed to hold them all, to protect them from what, clearly now, was a dangerous world. He was now being drawn toward them, toward the house where they slept, and he wondered if that was the worst thing about death, in a way, your complete lack of volition, you were just drawn here or there, like molecules in the air, motes in sunlight, the exhale of some small animal.

It is not true, he thought, that the end is always peaceful, that no matter how you die, there will be a white light that bathes you in peace. He had always hoped, in spite of his medical training, that there was some mystical truth medicine could never identify or measure. Faith, he'd had a kind of faith and perhaps he still did, but no, there was no peace. There was a wrenching in his heart and gut that had nothing to do with the knife and everything to do with being torn from this life, away from Denise and Andrés and Juliana, away from his work, away, even, from something so simple as the moths beating their wings against the street lamp.

 

"Was it a heart attack?" Denise asked the detectives.

Later, when she remembered that night, she would remember their faces as bland ovals. They looked like they had stepped out of a comic book, had been drawn with a few economical lines. It was as if the looks on their faces, looks of concern, she supposed, had been smeared over with one of those pink flesh colored crayons so that their features were indistinguishable.

And their silence. The silence of the detectives increased her feeling of disorientation. Was anything real? Were they sitting in her living room? Were they wearing dark slacks and white shirts? If she put her hand out to touch the one on her left, would it go right through him? She felt as if she were in a science fiction movie where everything, even the premises of matter, could be in question. She had opened the door, hadn't she? Had she opened it to tragedy? If she had stayed in bed, would this scene even be happening? If she had kept her eyes closed, would all of this become one of those dreams, those dreams so vivid they seemed like memory?

Or maybe their silence meant anything, everything, was still possible. He was shot, but not dead. He was missing. He was alive. He was a witness. He'd had a heart attack. A car accident. Was lying in Emergency this very minute. A broken ankle. A fractured wrist. One could hope. Even shattered bones in his hands, she could take that. He could adjust. Surgery wasn't everything, she'd tell him. Until the detectives spoke, until words narrowed all possibilities, fastened all options, made the irrevocable real, nothing was certain. 

"He was found," the one with acne scars paused, "his body was found in the parking lot. His car is missing."

"We're sure," the taller one said. 

It was the taller one who was sure.

 

Who can imagine, then, the rest of the night? After Denise showed them to the door. After she trailed her hand along the wall in the long hallway to steady herself. Patrick dead? If that was true, then anything was possible. In the future, when people would say to her, at the funeral, for instance, well, the worst has happened, she would think: oh, no, this simply means that the worst can happen. I am not immune. I could lose everything. Even the children. 

The children. She would have to tell them. But what would she tell them? That was Patrick's job, the explaining of difficult things. He was the steady one, the one who kept everything from spinning out of kilter. She needed him. They needed him. How could he have left her alone? This is the moment she felt the wrenching, for what else can such abandonment be called? 

She doubled over in the hall, could not get her breath, something was twisting her heart. It was true, her heart hurt, it was breaking. Or maybe she was having a heart attack. She couldn't breathe. She squatted in the hall, tried to catch her breath and saw it, the glint of the blade. It flashed, unbidden, promising relief.  Only pain could erase pain. After her mother had died—when she was a teenager—she'd cut letters into her thigh with a razor blade: there, I am marked. As I am inside, I am outside.

 

Then. She knew it was him. His hand, steady, warm, his hand on her back, like in the middle of the night when she could not sleep. His presence said, the children. Simply, the children. And his hand led her to their doorway. It was as if he were reminding her, the same way he had when she awoke with nightmares of her mother's death. In the dreams, she was sobbing as she had never allowed herself to sob in life. Sshhh, he'd said, the children. You have to think of the children. You are not the center of your own world, but you are the center of theirs.

She stood in the doorway. They did not seem restless, disturbed in their sleep, but how could she tell? Perhaps, like her, they were seeing his eyes soft and brown behind his glasses. His hands, long fingers like hers, thin fingers like hers. His hands on the keyboard of the piano, explaining to her the geometry of the keys. Had he held his hands out in a plea or in defense? Perhaps, like her, the children would never be able to imagine his hands or eyes again without also imagining his fear and pain. Or perhaps they were dreaming about yellow ribbons. Wondering, why yellow? Why ribbons?  

Perhaps she should be thankful they were so young. They would have so few memories of their father, they would never be able to imagine him falling. Patrick, falling. Falling, not fighting. He wasn't the kind to fight. His face was probably bloodied. His blood pooling on cold asphalt, darkness made darker. This new Patrick hovered on the periphery of her vision, and she was afraid if she turned her face quickly, she would see him: Patrick, helpless, Patrick, the color drained from behind his skin. 

 

If he didn't think she'd take it the wrong way, Patrick would remind her that he was only one of ten homicides in Tucson in the past twelve days. He found this fact astounding. Well, appalling, he supposed that was a better word. And three of the victims had been teenaged boys, Juan Varga, Steve Layne, and Rene Vasquez. Teenagers, even if they were into things they had no business doing, didn't deserve permanent consequences. Then there were the others: 65-year-old Hilary John Smith, 28-year-old Anthony Jones, 32-year-old Peggy Swanson, 55-year-old Maria Guadalupe Chin and her husband 65-year-old John Chin. He wondered about the married couple. Homicides? And two unidentified women, which made him really sad. Unidentified, unmourned, their passing unmarked—had they no homes, no family, no jobs? No one to mark their absence? His death would be in all the newspapers, on news programs, and, in some grotesque way, would come to define him. He was no longer a talented young surgeon but a "slain physician" and two hundred and thirty-two people would show up at his funeral service. His patients would plan, as a memorial service, a Children's Walk up Sabino Canyon in December. Over seven hundred people, half of them children, would show up for that. He hoped he'd still be around to see it. One of his patients, five-year-old Danny, would ask his mother to make a scrapbook as a gift for Andrés and Juliana. He would say to his mother that he thought it would be nice to get pictures and stories and put them in a book and so she would do just that, call together a few other parents. Patrick would find it moving to watch them, gathered around a kitchen table, pasting pictures of their recovering children, his patients, and their letters into a scrapbook they would present to Denise at the service. And he'd loved seeing the pictures—there was little Eva, before and after, Stephen, his glasses held on with an elastic strap, Molly, Annie.

What a kind gesture, he thought, but he was only one of ten in the past twelve days, only one of forty-five for the year. In those same nine months, 585 Americans had been killed in Iraq—he wanted to tell Denise this, thinking it might give her some perspective, as it had him, once it had been brought to his attention—almost 1100 since the start of the war and they estimated, oh, he had watched them trying to figure this out, the estimates of the Iraqi dead, anywhere from 80,000 to 128,000. Men, women, and children, not to mention the elderly. Sometimes it was hard to sort out those who would have died anyway from those who died from causes related to the war, this was a point of contention, but he thought 100,000 was probably not only a round number, and therefore memorable, but an accurate assessment. 

 

He had become obsessed with death, to tell the truth, drawn to places where the souls exiting caused a rush of wind and he wished he could talk to Denise about it, tell her that it didn't make him feel tiny, insignificant, not in the ways they had talked about before, while he was still living, when they had stood out at night under the stars and looked up into the heavens and talked about the light from the stars burning out and light-years and fractals and grains of sand. The after life, so far, had been a very crowded beach. There were, after all, 80 billion dead, as opposed to the 6 billion still living but, oddly enough, instead of feeling infinitesimal as he sometimes had in life, this communion with other departing and departed souls made him feel part of a larger something, something indestructible, maybe the fabric of living matter, maybe energy or light itself. 

The totality of light can never burn out, he wanted to tell her, but he wasn't sure she would understand what that really meant. It was such an abstraction until it happened to you. In fact, in some ways, he felt that in losing his body, he'd become all mind instead of all spirit, as if his mind were merging with a larger mind. 

 

Medical City. Baghdad. There had been another suicide bombing, Level 2, which, he now knew, meant an attack resulting in 20-50 casualties. When an explosion occurs, this was how the locals put it, as if explosions occurred, they just occurred. Was there a special tense for that, he wondered. Passive? Speculative? But when the attack occurred that was how he'd come to think of his own death. When the attack occurred, not when he attacked me.  When the accident occurred, when the attack occurred, when the explosion occurred... it seemed less painful, less personal that way, he supposed. But there was no time for semantics now; now the patients and others, the not-wounded, the family members, were pouring in. The guards had met the ambulances outside, were checking everyone, even the victims because it had happened before, a second bomber disguised as a victim, detonating a bomb inside the crowded Emergency Department. Today the bomb had gone off in the bird market, families, women, children, it was inconceivable, still inconceivable to Patrick, that this could happen, happened daily, several times a day. This trauma to the world, shrapnel tearing through human bodies, bombs designed to do as much damage to flesh as possible, packed with nails, with screws, even with the nuts when they ran out of screws. 

The noise in Emergency was incredible, the wailing, the sound of the children, the medics and doctors and nurses, their voices, and the blood, he was used to blood and yet it bothered him, the smell, the amount of blood, even on those who had not been injured, and some didn't realize they were injured, thought the blood was someone else's, the child, the wife, the brother they were holding. The floor soon slick with blood. Many patients, most patients presented with multiple wounds and there had to be triage, some assessment of what could be done immediately, who would go back to an operating theater, who could wait, who would be left to die. It was that simple. The doctors, what doctors there were—most of the older doctors had left the city or had been killed—were young, students, but they seemed to know what they were doing. This was good training, he had to concede, they had to make quick decisions, prioritize because most patients required multiple procedures: trauma surgery first, then ophthalmologic intervention and then orthopedic if they survived. And if someone died, if mistakes were made, well, what could be done about it? What, really, under these circumstances? 

So this was where he was needed most, at least at first, because they had no ophthalmologists on staff, not here at Medical City, they didn't. Head injuries were hallmarks of suicide bombings—49% of all patients had them and 30% were under fourteen years old, he had learned this, too, somewhere, and so eye injuries were common, of course—and on this day, just on first glance, it was apparent that at least six patients had ocular or periocular trauma, two of those children. 

Patrick was standing next to a young doctor. The child he was examining, airway, breathing, circulation all seemed to be fine, but a possible open globe injury. There were lacerations to the face and to the eyelid. Obvious corneal and scleral lacerations. There, he thought to the young doctor, dark uveal tissue presenting on the surface of the eye. This is an open globe. We need a hard patch, a rigid eye shield, to prevent an expulsive hemorrhage. Do not apply pressure, do not manipulate the eye. 

He felt his hands moving through matter, his hands, they knew what to do, but could not do it even if a hard patch had been available. A hard patch and an IV, ciprofloxacin, 500 mg. were needed but of course, were not available and so Patrick watched as the young doctor put a patch over the eye, gauze, it was all he could do for now, keep the wound as clean as possible. At any rate, the child would not die. The child would lose his eye, Patrick realized this now, most certainly, it would require a primary enucleation. Enulceation, just the sound of the word made his heart sink, the loss of an eye that could have been saved. But the child would live; he would have vision in the other eye. The young doctor moved on to the next patient.

Here, in Emergency, is where Patrick was needed but even if he had been able to perform surgery, there certainly wasn't an ophthalmic microscope in the trauma room, nor was there a high-quality neurosurgical microscope to take its place. Please. A high-quality neurosurgical microscope?  In July the Iraqi National Guard had destroyed the ICU because one of their own had died, even though he'd received the best medical care they could have given him, and then they'd threatened the medical staff. If you'd told Patrick five years earlier that it was dangerous to be a doctor, he wouldn't have believed you, but here he was, dead, and so, evidently were several others, just because they were doctors, three in the past year from this hospital alone. 

From what Patrick could see, quickly moving through or, rather, hovering over the Emergency Department, three eyes needed urgent primary closure of a laceration for repair of open globe and two eyes needed exploration of subconjunctival hemorrhage. Three eyes, he thought, three eyes, in the very least, would require further surgical intervention for the extraction of intravitreal foreign bodies. Of course, that could be done later, after the patient was stabilized, even days later, once X-rays were available. X-rays could rule out metallic foreign bodies but they'd need CTs for glass or wood or bone fragments. CTs, another item missing from the list of missing items, the very long list.

A few days earlier, there had been a Level 3 and the bodies had been laid out on the Emergency Department floor, white cloths and foil blankets covering them, and when the hospital was full, the bodies were laid side by side on the footpath in front of the hospital and the people came by, looking for their relatives, lifting the covers in their search.

 

Tikkun olam, he said to Denise. I keep thinking about that phrase. The repair of the world.

When he was in high school, he had joined a youth community service program called Social Action Tikkun Olam where he and other teenagers had served food in soup kitchens and collected blankets and clothing for the homeless. He'd not been a religious Jew, and neither had his family been religious, but he liked doing such work well enough. He'd met some pretty girls and felt virtuous, but he also knew it looked good on his applications for scholarships and so, since his work was motivated by a selfish desire, how could it—he now wondered—have brought him closer to the light? And that was the idea, as he understood it, that doing the work of repairing the world brought you closer to the divine.

It's hard not to see it, he said to Denise, how much the world has been torn apart.

Our world, she said.

Yes, our world. But also... he paused, the images of the women in their abayas bending over the bodies of their children. Who could deny that the loss of one person was the loss of a world? All those clichés, he thought, but here you lost all cynicism, here you realized there was some truth to them. Each person was a world. All the world in a grain of sand, wasn't that Blake? And returning to light—tikkun olam essentially meant returning to light—a phrase he'd always found cheesy. To walk into the light, he'd always thought, was just a metaphor for the way that energy never dissipated, a way that the scientifically, rationally minded could understand eternity, and yet now he knew there was some fundamental, some unexplainable truth to the interconnectedness of all things, even in such a random universe.

This is the story, he told Denise: God created the world by forming vessels of light but as he poured Light, Divine Light, into the vessels, they shattered, the shards falling down into the world of matter, and so our world is full of shards of light that need to be returned to Divinity and we can only do this by repairing the broken world.

Before, it hadn't made so much sense, the idea that physical acts could also be spiritual acts, that doing them brought you closer, if not to God, then to the Divine in yourself, a Jewish version of Nirvana, he supposed. In college, he'd heard people, the religious Jews he knew, argue that tikkun olam had come to be over-used, to mean everything from social justice to feeding the hungry to environmental work to raising money for Israel—even to supporting the creation of a Palestinian state. How could a word, they argued, that meant everything mean any thing? 

But now he understood it better, if everyone tried to repair the world, the world would be closer to the way God had intended which is maybe why Jesus, who was a Jew—as he'd always pointed out to both his Jewish and Christian friends—had taught them to pray: Thy will be done, on earth as it is in heaven.

And what about Islam? He didn't know anything about Islam except what he'd seen recently, that its fanatics seemed bent on destroying even one another, further renting the fabric of the world rather than repairing it. And in God's name.  Well, of course in God's name.  It was an irony older than the Crusades.  In the Aleynu prayer, weren't Jews praying for their God's sovereignty? He'd always found that disconcerting.

Do you understand any of this? he asked Denise.

No, she said. 

Then: yes. She understood shattered. Her world had been shattered. She felt like a shard, a sliver of herself. She felt in despair of ever being whole again.

So God's absence proves his existence? she asked him, suddenly angry.

Is that what he wanted her to say?

 

Over at Ibn Sina in the Green Zone, it was a different story, Patrick realized. Oh, they treated everyone there, US soldier and terrorist alike, each one was a patient first and an individual second, but that hospital may as well have been a universe away from Bagdad Medical City. Clean. State of the art. Equipment they didn't even have in the States. Now they had a high-quality neurosurgical microscope in the trauma room and with its long arm it could be placed at such a distance and such an angle that Patrick could have worked without disturbing the anesthesiologists and trauma teams. Not that working at Ibn Sina wouldn't have been gruesome or stressful or draining, of course, but it was also a dream from his point of view, from a purely scientific, a purely medical point of view. Each doctor did probably seventeen major trauma surgeries per day and although the wounds were often disfiguring and often involved multiple amputations—he never had been able, quite, to separate the procedure from the patient—he would have learned new techniques, just think, more than he could ever have learned in a lifetime. Simple bullet wounds, for instance, like those back in the States, they called those recreational wounds—the damage caused by a high-caliber bullet or shrapnel or a rocket propelled grenade, the wounds they saw here, those could be six inches long, easily. It was unthinkable that anyone would have survived them even five years ago, but as long as they arrived at Ibn Sina within the golden hour, ah, the golden hour, that's why he had tried so hard to get back into his office, he remembers now, thinking, if he could get help within an hour, he would survive. Of course, it was probably not so. He probably did not have an hour, even had there been someone to help him and, surely, the University Medical Center did not have a Belmont rapid infuser, a machine he had come to covet because it could inject a unit of blood into the body in thirty seconds. Thirty seconds. Imagine. Instead of the drip method which takes as long as fifteen minutes per unit. In one surgery he watched, the patient needed thirty units of blood! Thirty units and he'd survived! A sniper's bullet had entered his back and clipped the hepatic vein right where it emptied into the vena cava. Patrick had watched the doctors' bowed heads, their gloved hands, the nurses, the anesthesiologist, all focused on this one patient. There was a reason they called it a theatre! Massive bleeding, that was the problem. There was no way they could do damage control surgery. This case couldn't wait. They'd had to isolate the damaged section with shunts; it was the only way they could operate at all. 

But in Patrick's case, he couldn't help but think about this as he watched, he'd had so many wounds, seventeen of them, he thought, many of them super-fatal, a blitz attack, isn't that what the coroner had said? How many hands could possibly have reached into his body, so small a space, really, some of the wounds so close together. Cut to ribbons, he thought, cut to ribbons. I was cut to ribbons. One third of the blood from my whole body pooled there, in my chest cavity. It must have been a scalpel; it was so clean, the first wound, the blood, surprising.

 

Holy One of Being, I am yours and my dreams are yours. I have dreamed a dream and I do not know what it means.

Where is that from? she asked him. He had always been able to delight her in that way, by saying something completely unpredictable. She felt, at once, still close to him, her heart warm, as if it were expanding, and then, immediately, breaking again, broken, bereft. He had already been torn away.

Whatever healed also cut. That was the first rule of grief, she knew.

The Talmud. See? In being part of the larger mind, I have not lost my individual mind or memory.

And how long will this last?  How long will you... linger?

She wondered if that was the right word. It sounded so 19th century, so Emily Dickinson, somehow, because I could not stop for death...

I don't know. I would like to say for as long as you need me, but I don't know. He sighed. It must have been a sigh. 

In the morning, you'll need to get up, Denise, and go on with living. Start with a shower. And then a cup of coffee. Make breakfast. Kiss the children for me.

Kiss the children for me.

He used to always say that when he called her from work.