A few weeks ago, I had the great privilege of photographing a wedding for one of my closest (and tallest) friends. It was the first time my subjects were non-knitted, living things, so, understandably, I was a bit nervous. In the months leading up to it, I bought photography books, read online wedding blogs for must-have shots (first look, processional, fallen bouquet along a row of chairs, etc.), and planned to go out on several practice shoots, but then I found some grey yarn and decided to make five more yarn cats instead (bringing my total cat count to just short of thirty. i’m empty inside.). Add to this the HBOnow account I’ve newly acquired (six seasons of veep, four seasons of silicon valley, one season of big little lies) and you have the reason why I had to google ‘how do I turn on the flash on my DSLR?’ the day before the wedding.But despite having to (literally) dust off my camera before flying out to Portland, Maine, everything turned out pretty well! I took a whopping 1,500 photographs in forty-eight hours (the majority of which were close-ups of animals and babies), and midway through the family portraits I had the pang of fear that I believe is familiar among all wedding photographers, when I suddenly wondered if there actually was an SD card in my camera (fauxtography?) and imagined all the ways the mother of the bride would torture and then subsequently murder me (red wedding?) to ensure I never take another picture again.Okay, so according to all my sources (photog’ blogs), this is the part where I run through the entire wedding in picture form and talk about how amazing it was working with the happy couple. But since only one in five of my shots were salvageable and I spent an inordinate amount of time hanging out with the venue’s four sheep, I’m just going to show you some that I feel turned out the best and/or had good lighting (and/or could be in a men’s warehouse commercial #you’regonnalikethewayyoulook).Not shown: The groom’s Magic: The Gathering tournament (which I thoroughly dominated), my two best friends: Stanley and Nina (dog and infant, respectively), and my accidental candids of people walking into Porta Potties.
Other than weddings, Veep binges, and unarguably too many cats, the past few of months have also been busy with fourth year/residency application tasks (and hearthstone, which i re-downloaded in a moment of weakness). This month, I am helping out with the Anatomy course, trying to convince everyone (mostly myself) that my knitted-eye-in-a-used-shoebox is even comparable to the 3D printed one that took all of twenty minutes to make. In September, I submitted my residency application and only woke up in cold sweats once (was that my personal statement i uploaded or actually just a list of inappropriate broad city jokes?). And in August, I worked in the Pediatric ICU, which was both extraordinary and devastating. You can read more about it below.
Oh yeah. Also, in case there’s any doubt: as irreverent as I am towards the personal space and privacy of others (one time i unknowingly followed my resident to get a pregnancy test. for herself.), there are some things, like HIPAA (and richard splett and the rule of thirds), that you just don’t mess with.
The Pediatric Intensive Care Unit sprawls across the fourth floor of a six-story hospital, which my grandmother would have had a fit over if she were alive today. There are about three halfsteps separating ‘four’ and ‘death’ in Chinese, which I am convinced I hear taunt me as the elevator dings my up from the first through the second and third to the fourth floor. I imagine her wagging her head and giving sharp, disappointed exhales. She’s clicking her tongue at me, at all of us naysayers for ignoring those wayward, tone-deaf spirits she worked so hard to ward away. As the elevator doors open, I smile tongue-in-cheekishly, thinking about fortune and curses and superstition and ancestors, but it’s gone by the time the elevator doors close behind me.
My grandmother was admitted to an intensive care unit of her own late last year, tucked into a small, private room along the U-bend of a nursing station overlooking boxy San Francisco apartments crowded together like teeth. It was Christmas and warm, a day like many others with bright skies and a salty breeze.
She died in room 404.
In the PICU, patient rooms are arranged in a horseshoe pattern, so half the rooms overlook a sawtoothed cityscape and, on a clear day, a tiny smudge of Gary, Indiana peering out from across Lake Michigan, and the other half overlook the thick trees and stubbly parks of the South Side that stretch across the flat expanse to Naperville and Downer’s Grove and innumerable other Chicagoland suburbs. The walls are plain and unimaginative. Room numbers are cuts of white, set deep in purple plaques affixed along each doorjamb. They dangle as if caught mid-fall or assembled haphazardly. The floors are shiny—severely bleached and polished regularly—and tiled as broad swaths of nude brown and sea foam. Altogether, the PICU feels childish yet neutral, cartoonish exaggeration suffused with an air of stiffness and dry forgettability. As I breach the double doors, it feels like I’ve entered a classroom, clean and expectant with desks bare but well worn, awaiting the first bell of August after a lonely, uneventful summer.
On the north end of the floor, closest to the elevators, the nursing secretary sits at a long desk in front of a row of phones, flanked by a fax machine and two large filing cabinets housing blank consent forms, insurance paperwork, menus, and the like. Directly behind her is a tubing station—a carpeted nook the size of a hotel room safe recessed into the back wall below a 9-digit keypad. Nurses stop by periodically to send paperwork and vials of bodily fluids across the hospital grounds. In passing, I’ve seen parcels docked in plastic football-shaped encasements jettison off into oblivion, and I picture a maze of pipes knotting itself beneath the walls, a steady traffic of prescriptions and blood samples all winding about labyrinthine with business-like efficiency.
On the south end is a nursing station, complete with telemetry monitors, a crash cart, and an omnicell—a vending machine-like apparatus that dispenses bottles of medication, except instead of dollars and change it charges a thumbprint and four digit passcode. The alcove by the windows serves as an unofficial parking lot for spare ventilators and out-of-battery mobile workstations. They are herded together, tethered to the wall by thick, spiraling power cords. From a distance, they look almost sentient, a family of idle robots, dozing like cats in the warm midday sun.
In the center of the PICU is The Fishbowl, a conference room for residents and medical students with a floor-to-ceiling window that makes up its entire eastern wall. The glass is clean except for scraps of equations in dry erase marker, bits of volume and pressure loops and a boxy pair of lungs. Despite its name, the window is hardly ever used. Admittedly, it’s not an exciting sight—a couple of computers, stacks of review guides and procedural glossaries, and a long table littered with sign out debris and stale breakfast. Nurses march in and out several times a day, and parents walk past without even so much as a glance, the path between their child’s room and the family shower and bathroom so well worn that I doubt they even see us anymore.
Rounds start with room 441 by the elevators and finish at the other end of the nursing secretary desk with room 474. It’s a boringly medical process, but resembles Christmas caroling in the way we cluster together and migrate door-to-door, quiet chatter falling to a hush as the door opens and Mom or Dad comes out to greet us and listen to what we have to say. At room 441, it’s Mom (and we call her Mom, as automatically and affectionately as if referring to our own mothers), and she leans against the entrance to her son’s room with her arms crossed in front of her chest like we’ve arrived with handcuffs and an arrest warrant. But despite this, her face is soft and attentive, her eyes bleary and hair tied messily into a bun, knocked aslant by the sofa bed she just got up from.
441 is one of mine—as is 445 and 453—so I begin presenting, reading from my quarter folded piece of paper and nodding towards Jason when I mention his name. He’s laying in his crib behind Mom, obscured by frosty tubes feeding in and out of him, his ventilator metering out twenty-five mechanical breaths per minute. I talk quickly and without much inflection, slipping into medical jargon with words like ‘asphyxiate’ and vague acronyms like ‘CPA’ and ‘HIE’ to avoid having to say what actually happened to him: Mom fell asleep last Thursday breastfeeding and woke up with Jason blue and lifeless beneath her. I feel cruel repeating this history every morning in front of her, and no matter how much I try to intellectualize it, my words come out sharp and threatening, growing black and winged each morning to scratch at a nightmare that refuses to be forgotten.
But somehow I get through it all, my subjective, objective, assessment and plan, what we’re uptitrating and downtitrating, all the ways in which we’re supporting his fragile lungs and the pie slice of brain tissue that still has a semblance of normal cortical activity. I gloss over the greater question, the one about life and death and the hellish territory in between that so many of our patients seem to find themselves in. From the pregnant pauses and how close we’re all standing to each other, I can tell that that discussion has already been had, or at least initiated, and for now we’re still managing Jason as expectantly as if he has a broken arm or leg or a bout of the flu. But I can hear the eggshells crack beneath me and think that this won’t be the case for long.
Rounds are dragging on and residents are getting antsy. We ask Mom if she has any concerns. She looks into the room at Jason, and for some reason we look too, as if expecting her two-month-old son to sit up and complain of the scratchiness of his feeding tube or the pressure settings on his ventilator. As she turns, I see her neck, tattooed with her son’s name, the black cursive snaking from beneath her bra strap and across her left clavicle. Her skin beneath is tinted, airbrushed with a light pink so that the name itself is set on a backdrop of stars, carved into the dusk sky by showers of meteors and comets. I wonder how long ago she got it—before The Accident, of course—but whether it was before he was born, or conceived even, when he was still just a name, an idea, safely swaddled in non-existence, immune to hypoxia and impervious to smothering.
Her tattoo reminds me of the couple and their daughter who stayed in this room two weeks ago, when the PICU was an alternate universe, the same facilities but an entirely different population, each one oblivious to the other: Dad had a loud sleeve of tigers and other predatory animals painted green, blue, and red like mah jongg tiles. It suited him, his strong features and solid build. It seemed to stem from the fraying edges of his sweat-stained wife beater and race down his arms. When he reached to shake my hand, an entire stampede came racing toward me. Mom, I remember, had only one (at least only one that I could see)—a tiny heart on the inside of her wrist, picked up like a charm for a bracelet. An afterthought of ink, but intimate and precious. It sat just atop her radial pulse, and I wondered if she did that on purpose, so that if you watched carefully, you could see it bounce up and down along her skin, two hearts beating perfectly in sync.
We leave awkwardly in a flurry of smiles and nods and unspecified ‘thank you’s. I feel good—as good as you can feel taking care of a dying child—but with the faintest shadow of guilt. At this point, I’m less of a caroler and more of a traveling salesman, our increasing distance reminding us how separable we are as people. It is now me versus her, and there are winners and losers, and I feel like one of the winners—but also maybe one of the losers. I wonder what Mom feels like. I turn around, but she’s already gone, back in her son’s room and leaning into his crib, giving him a bath with a damp, cotton cloth.
We work our way around the horseshoe slowly and systematically. One room has a large piece of butcher paper taped to the door—an oversized, ornate get-well card collecting handwritten well wishes and prayers from visiting family, friends, and kindhearted house staff. His name is Jamarion and both Mom and Dad are already waiting for us when we arrive. I watch their faces while I present, the way Mom’s eyebrows worm around like a pair of Chinese fingertraps as she swings from concern to relief to concern again, how she looks from member to member of our team but Dad is staring unerringly at my attending, who himself is silent and looking down at the ground. I look for tattoos, tiny licks and tails creeping out from beneath the straps of two dollar flip flops and the hem of oversized basketball shorts or Target fleece pajama pants. I look for signs of anger and sadness and misunderstanding and frustration, signs of us and them, winning and losing. It’s no surprise, though. We will be the winners; we always are. I look at Jamarion, whom no one is talking to but everyone is talking about. He’s standing in his crib, face to the bars like a roped in outlaw, delayed and nonverbal but detesting the way the nasal cannula prickles his nostrils.
Rounding ends in The Fishbowl, where our tasks for the day are listed and divided, and then, for some time, there’s quiet, with only crisp keyboard clicks and pagers (which go off so frequently they don’t even register as sound anymore) filling the air. Through the long window I can see into room 456, where a boy with a head too small for his body is breathing heavily through a Bane-like mask, his face awash in chalky mist. Mom is a bundle of white blankets asleep on the couch. Normal saline waterfalls into the crook of his arm and neon green carets flutter across the monitor impressively. He’s not dying, which is one-liner I heard someone give about him the other day before reaching over and knocking twice on the plastic railing. I think of my grandmother, who was on a fourth floor just like this eight months ago, and in the quiet of note-writing and order sets and text paging, I rap my knuckles twice, softly, on the long conference table.
The rest of the day proceeds at a sleepy pace, and after phone calls and faxes, med recs, observing a few waves of hypertension, and modifying tube feeds and scheduled diuretics, it’s the end of the day and I am leaving The Fishbowl, walking to the double doors. On my way, I see moms and dads. They’re sitting, waiting, talking, hovering, making phone calls to elementary schools and work supervisors. They’re magicians, squeezing fifty hours into twenty-four, scheduling a journey to death and back between carpool rotations and work deadlines. Some startle as I cross their sight, getting up on instinct, thinking that I’ve come with updates on their child, lab results or imaging reads, ‘bad news’. But I only offer a small, closed-mouth smile with a slight nod and continue walking, a ‘given the circumstances’ version of a quick hello and goodbye. Healthy siblings run by my feet with an energy and volume I forgot children were capable of.
Through the double doors and in the elevator, I feel lighter as I drop from the fourth through the third and second to the first floor. Commas become periods, and I can take a breath. Through the glass lobby past the reception desk are shirts and ties and shoes with laces on them, and I’m thrown by all of these layers unruffled and intact, warm heart stones still protected by fleshy pulp and peach fuzz skin. Through the automatic revolving doors, South Maryland Street is bright and noisy. Cars, uneven curbs, second hand smoke, cycles of violence. The world is full of many sharp things. Today, my attending joked about how, after admitting a girl who choked at a church barbecue, he told his own children they were allergic to hotdogs until their mid-teens. So I guess the world is full of many dull things, too. Through the breezeway, a powerful wind throws my tie into my face, and I am in transit between worlds—between day and night, work and home, four and death—the cool, silent slipstream below, and above: a catastrophe of sound, filled with unseen monsters clawed and leering, reaching out from within the dark.