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Managed Care

It’s times like this that studying Buddhism comes in handy. “Stay here, now” I say to myself again and again, “be with this moment, and whatever it feels like, feel it. It’s all you really have, this moment, right here.” I am calm when I talk to my mother on the phone, and when I visit her, finding true pleasure in the fact that she will eat the milkshake I brought her after days of taking no nourishment but water and air. I am patient with the good-hearted and perky male nurse as he explains to me earnestly that they “had” to give her morphine to ease her breathing even though it is written all over her chart that she cannot ever, ever have opiates or benzos because she can’t process them with her lone, donated kidney without at least a week of delirium. I am even able to stay relatively placid when my father, not in good health himself, describes the morphine-fueled reaming he received last night when he visited her to say goodnight.

I ride the waves of anguish at the small, daily losses, and the pangs of guilt as I speak rationally about “quality of life” and the standing DNR that is at once reasonable and horrifying. I am thrilled when we have a good time, a good talk, a connection that brings my real, true mother back into the loop of my life.

I reassure myself in the grocery store that it doesn’t matter, in the long run, if my son eats vile, processed food for a week when his father is away on business and I am eating at the hospital. He is blissfully happy to have Tyson Any-tizers and other toxic sludge for one time in his life, and I understand that I have neither the time nor the energy to whip up healthy dinners that bridge my vegetarianism and his adolescent voraciousness.

I am present.

I am not anxious about what comes next, most of the time, and I can talk to my father about taking “one thing at a time” rather than spinning into a panic and wasting available energy. I tell him to nap, I make him Vichyssoise garnished with fresh dill from my garden. I find him a support group and send my son to water his plants and take out the dog. It is not a question of being particularly “good” on my part; it is a facility I have, and it’s easy for me to take care, to nurture, to soothe. I tell my husband it’s too bad I can’t get paid to do what I’m doing, but I’m not sure I could do it for people I did not love so very deeply. It is not about assuring a place in heaven, which neither my mother and I believes to be an actual destination, but about taking in every moment with all my senses, from the stale air of a hospital room to the pressure of dogs sleeping beside me when I can finally lie down to sleep.

Then there is this: I am speaking to the intern who is making rounds for my mother’s primary care practice. I ask him why anyone would give her morphine when the consequences are so well known and so awful. I ask him who, exactly, is coordinating the care of this woman as a whole person, not as a donor kidney, a waterlogged heart and a pair of exhausted lungs. He begins to repeat back what I have said, prefacing his recitation with an assurance that he “understands my concerns.” Which means that he doesn’t. Which means, actually, that he is using a technique he learned three weeks ago for handling difficult patients and family members. He is going to complete his recitation, a placeholder, and tell me why everything they are doing is reasonable.

He hears my concerns.

I snap. “I understand that you are managing me,” I say curtly, very un-Buddhist, calm only in tone. “I am asking you to do your job and answer my questions. If you can’t perhaps you could direct me to someone who can help me.” He apologizes, and I feel guilty because I have, somehow, tried to tip some of the weight I am carrying onto his shoulders. I didn’t realize that there was so much anger, so much frustration, and such bitterness in me. I apologize, too.

It will all be as it should be, because everything, ultimately is. I have no control, only the ability to immerse myself lovingly, and to let myself absorb everything from the cold metal of an IV pole to the sun-bathed green of the leaves outside. Managing life and death is an illusion. Living is not.



About imagineannie

I feel like I'm fifteen - does that count? I'm lots of things, I get paid to be the Managing Editor for a local news publication, and I love my job. I am also inordinately fond of reading, animals (I have four), elephants, owls, hedgehogs writing, tramping in the woods, cooking India, Ireland, England, avocado toast, Sherlock Holmes, Harry Potter, Little Women, Fun Home, Lumber Janes, Fangirl, magic, Neil Gaiman, Jane Austen, YA books, not YA books, classical music, Salinger (OMG SALINGER), Brahms, key lime pie, indie music, podcasts, sleeping in, road trips, marmalade, museums, bookstores, the Oxford comma, BBC, The Miss Fisher Mysteries, birdwatching, seashells, kombucha, and stickers. Not a huge fan of chewing gum, jazz, trucker hats or dystopian and/or post-apolcalyptic fiction (but I'll try anything).

2 responses »

  1. It’s hard, isn’t it? But I’m sure you can be firm as a Buddhist, you don’t have to be a push over, nor accept someone being subtly rude.
    Some very good points here… just going back to re-read this. Thanks for this!

  2. Linnea Priest

    Tell the hospital omsbudsman or patient complaint adjuster (they all have one) about the morphine. Truly, they should not give morphine, ever, when this is written in the chart. If they don’t behave, threaten to call the Joint Commission on Hospital Accreditation….that is the boogeyman for hospitals!


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