A Final Sunset

A closish acquaintance lost her twenty two year old son today. The death of a child hits close to home. Shortly after our own X died, I was working for a good man whose sixteen year old daughter was killed by a car walking home with friends. The death of a young person is a sobering wake-up because it defies expectations. Things aren't supposed to happen that way, and even when the outcome seems likely (as was the case with X) a child's death is still a very painful surprise.

Today was still a good day, and I'm grateful for the reminder that none of us are guaranteed a chance at tomorrow. Every sunset and sunrise that we are given the opportunity, by the universe, to witness is a special gift.

College Creek Sunset

Today wasn't the most colorful sunset I've witnessed out on college creek. In terms of vividness it's probably not even in the top ten, but I got to see it and I'm grateful. I'll bet Frankie would have loved to have the opportunity to bear witness to the celestial crossing into darkness of the life bringing sun. He didn't get to witness the final sunset.

Every day on this earth is a good one. Every sunset is worth going out to see if you're able. Tomorrow, if it should come, is going to be a good day, and I'm looking forward to experiencing it with the gusto the greatest gift that is ever given deserves.

 

Any Given Friday

Today started off normally enough with a shortish hike down the Anacostia River Trail.

Yards Park Bridge Undulating into the Darkness

The weather is warming up nicely, and spring is most certainly in the air. The breeze is still cool, and this is probably one of the most pleasant times of the year to walk. With the passing of Daylight Savings Time it's now possible for me to catch the sunrise before hurrying into the first meeting of the day, and I welcome the return of the light to start the day with a splash of color.

Anacostia Waterfront with USS Barry

I happened to be running a little early this morning, so it was a dusky backdrop when I captured the daily shot of the USS Barry.  We have just a little over a month before she makes her way down the river. 

Later this afternoon, I went for the first jog that I've done since getting out of the boot on my left foot. Five weeks of downtime has led to a degradation in my fitness level that I'm not too keen about. This was particularly obvious because one of my running partners has used her time wisely and has put in some pretty serious distance over the last month. She says she doesn't feel fit or in shape, but she's cut one minute a mile off her split times, and I'm pretty sure she was holding back as I struggled along. Fortunately for me, I'm still about on par with the other partner because it appears he's not taken full advantage of the time to outdistance me.

During the jog, we were crossing the bridge over the railroad tracks near Pennsylvania Avenue, SE, and we came across a man laying in the road surrounded by the police. I'm pretty sure he was dead because no one was really attending to him, he was very still, and on our way back the ambulance left without the lights and siren. It is not the first time I've seen something like that, but it was a little unsettling.

On my commute back from work the family requested a Taco Bell run, and when I pulled up to the drive through I noticed that the mulch surrounding the ordering speaker was involved in a smoldering fire about two feet in diameter. I dispatched the smoky flames with the application of two liters of water and two liters of seltzer from the the back of the car. I made my order, made sure my bean burritos and soft tacos were on their way, and then reported my firefighting efforts to the cashier.  She said that I was the second person to report the smoldering smudge of a fire, and that someone had been dispatched to make sure it had been fully contained.

I've grown to expect some pretty fantastic vistas, although instead of becoming routine I'm growing to appreciate the subtle nuances of these land and waterscapes the more frequently I encounter them.  I didn't expect to run across a man having what appeared to be a relatively unfortunate end ot the afternoon, and after seeing that, I was totally surprised by the opportunity to practice my firefighting skills.

I've said it before, but life is a really remarkable experience when I'm able to focus on being right there in the moments that happen as it unfolds. Looking forward to whatever tomorrow might bring.

A Second Long Day

Today, I finished the actions that were at my disposal to complete my record that will be evaluated for promotion later this year.  I feel good that I've done what I can at this point.  Truth be told, I'm not really sure I want the promotion, but I've decided to turn that decision making over to others and the universe in general. There are a few reasons for this that involve a sense of duty or obligation, but mostly I believe that letting my will take charge and removing myself from the running at this point would be an exercise of ego for the most part. I'm not really confident that declining to compete would be a good decision, so I've put that call in the hands of fate.

I got a late start this morning, and my walking for the day suffered a bit.  I probably needed the rest more than I was willing to admit, and since I'm still on track for the threshold goal this month I suspect things worked out just as they should have worked out.

Anacostia sunrise with the USS Barry

Because I was running behind, I passed my usual picture spot in the magical moments just before sunrise. The air was brittle with cold and and there was not a hint of a breeze. The sun was rising just behind the ex-USS Barry, the reflection off the calm water was magnificent, and the waning moon and Venus cut through the inky blue twilight like a couple of magnesium mirrors.  This is one of the most spectacular vistas that I've ever observed at this location

The second day really started for me when we met with our daughter's neurologist and one of the residents from the Pediatric Intensive Care Unit (PICU) to discuss her injuries and prognosis. It seems to me that this was just after rounds near 0830, but this is just an impression and could be entirely wrong. The news we received at that meeting was not at all hopeful.

The neurologist related that the brain damage that was typical in cases with similar CAT scan findings twelve hours into the ordeal was almost certainly fatal. It was hard news to hear, and because our daughter appeared to be resting peacefully and might at any moment open her eyes and resume being a normal five year old (or at least normal for her) it was difficult to believe and accept. We asked some probing questions, and the neurologist admitted that certainty was impossible, but within the limits of medical knowledge there was zero real hope for any meaningful recovery. The swelling of her brain had probably not yet reached the maximum magnitude, but the damage that had already been done had reduced her neurological function down to the most basic subconscious functions required to maintain clinical life.  In fact, they had removed her from the respirator, and her breathing rate on her own was ultimately insufficient to sustain life had they not put her back on the machine.

The neurologist suggested that we may want to start considering the possibility that a decision to remove her from life support might be required in the future. She was on the respirator, she was being given a host of medications to moderate vital functions like blood pressure, she was sedated to block pain to the extent that we understand how that process works, but her life had been taken by the experience she had endured and her death was inevitable in the short term.

I don't remember the details of what happened over the next couple of hours. I think we talked about how we didn't want to give up too early even in the face of what we'd been told. We talked about the removing life support and things that we wanted to do before making that decision. We talked about sadness and disbelief. We asked for another CAT scan, and it was performed. The diagnosis of a fatal anoxic brain injury was confirmed. At some point in time one of us mentioned the possibility of organ donation and what that process might entail. I think we asked our nurse in the PICU about it. I believe he took our question to the doctor. More questions passed between us and the doctor. We decided to get more information. We decided that we did not wish to delay the inevitable outcome any longer than necessary, but we wanted her brothers and sister the chance to say goodby. We called my wife's brother and mom, and we made arrangements to bring the siblings to the hospital.

At some point in the process we spoke to a social worker about the possibility of organ donation, and she also agreed to interact with our daughter's brothers and sister when they came in. She arranged for us to meet with the hospital ethics advisor to be interviewed about the possibility of organ donation. We cried, and laughed, and joked, and cried.

A little after noon we talked to the hospital ethics advisor. She interviewed us and asked a series of questions that puzzled me a little. She did ask the standard questions about whether we understood our daughter's condition and the extremely unlikely possibility for any recovery. She asked about where we'd heard about organ donation. She asked if ANY of the hospital staff had mentioned the possibility of organ donation. Throughout the whole ordeal, none of them had mentioned a word about it. Organ donation was not raised once, and I found this also to be a little strange. I finally asked the hospital ethics advisor why she had basically interrogated us (gently of course) on this topic, and she told me that if any of the hospital staff had mentioned the possibility that the hospital would not have allowed us to pursue this option.

After about an hour of discussion, the hospital ethics advisor cleared us to talk to the non-profit organization that coordinates organ donors and recipient candidates in that geographic area. We'd signed numerous documents at this point, spoke to two hospital chaplains, one of whom we dismissed and asked to never see again. That request was honored. The other chaplain happened to be Muslim, and she was exceedingly comforting for me. I think my wife liked her as well.

More decisions about organ donation were presented to us. After a fairly long time considering the matter we made the decision that we would pursue an unrestricted path to donation. This cleared the path for any part of our daughter that might be used to help someone else could be used. Corneas, organs, bone marrow, bone, ligaments, and skin were going to be made available for transplant.

We were presented with the decision to remove life support or wait for a declaration of brain death. Due to hospital protocols, a diagnosis of brain death had the potential to take weeks or months to play out. We decided to remove life support, but first had to consider how this decision would impact the decision to allow organ donation. Removing life support would likely preclude a diagnosis of brain death and lead to cardiac death if her breathing rate proved insufficient to sustain life. Both of these paths impact the potential for viable organ donation. An organ recipient would not be able to use our daughter's heart if she experienced cardiac death. Also, if she sustained her own life for greater than one hour after being removed from life support, none of her organs could be considered viable for transplant. A diagnosis of brain death would potentially take weeks or months, and if at any time, she experienced cardiac death waiting on the required protocols to be met to permit that diagnosis, it was very likely that an operating room and the right surgeons would  not be available in time to permit her other organs to remain viable. We decided that we would accept the uncertainties associated with removing life support. I know I felt that was the more predictable outcome at the time we made that decision.

At about 1630, we brought her brothers and sister in to say their goodbyes. Hugs and kisses were exchanged. We held our sweet girls hands. We loved her. We gave her cards and some of her favorite stuffed animals. We cried, and laughed, and smiled, and cried.  We whispered to her and told her we loved her and that we were proud of her.

We expected that we would remove life support later that evening, and once we'd completed that hard and soulful exchange of farewells, we went out to the hospital flagpole.  Our daughter's brothers and sister were given the opportunity to raise the "Give Life" flag in honor of the sister's upcoming gift of a better life to someone else. The flag would fly as long as our daughter remained in the hospital and for twenty four hours after her death. If you ever see that flag outside of a hospital it probably means that someone there is having one of the hardest days of their lives and that someone else is getting some of the best news they've gotten in a very long time. It tore at the heart, but also gave hope. The mixture of sadness and triumph is the most spiritual thing I have ever experienced.

During our goodbyes and the flag raising, the organ donation coordinator had arranged for a series of lab tests and medical measurements to be taken and transmitted to the organ donor and recipient network to find possible matches. When the results came in, life intervened. A potential recipient's surgeon had asked if we could delay removing life support until the following morning to allow the best opportunity for a successful transplant to their patient. The doctors and organ donation coordinator told us that we did not have to wait if we did not want to, and that all involved would try to make things work in accordance with our wishes.  Life intervened, and we decided to spend one more night with our beautiful girl.

A Very Long Day

This morning, winter announced its presence with some degree (17 degrees as a matter of fact) of authority. On the upside, there was very little wind, but even at that the lowest temperature of the season so far tended toward bracing.

Anacostia River in the Evening with the USS Barry

I put in a pretty long day at work and walked just a touch over eleven miles today. All of that has become a matter of course, and that's not the source of this post's title.  To understand that, you have to turn back the clock two years.

Two years ago today, our youngest daughter left our house in an ambulance for a trip to the hospital from which she would not return. This is an eyewitness account, and I have to state up front that it is undoubtedly inaccurate in relating some of the details. Others who witnessed the events unfold will have different recollections. This is a brief telling of what happened from my perspective filtered through time.

I was awakened by an alarm from the pulse oximeter that she wore due to some chronic health challenges. We had been advised by more than one doctor that the use of the pulse oximeter was not really necessary but it did provide a degree of comfort that we'd know if something changed while she was sleeping. False alarms were not uncommon. When I entered the door of her room, I remember a sinking feeling as I looked at the machine and saw only dashed lines where her blood oxygen percentage and pulse normally registered.

I remember calling rather loudly for help and rushing to the side of her bed where I flipped her over and began feeling for breath and a pulse.  I could not find either.  Help began to arrive, and an ordered chaos ensued. Someone went to the phone and called 911. Someone set up the oxygen bottle and attached it to the ambu bag. I started CPR with my wife handling respiration via an ambu bag being fed by supplemental oxygen with the regulator open to full flow.  I think it was 5 L/min, but I'm not sure.

For some reason when I started chest compressions, I also started the stopwatch on my Timex. Her face had a bluish tint that pretty quickly began to get better as we progressed with CPR. The pulse oximeter that was still attached to her toe registered a pulse of 84 and a blood oxygen content that recovered to the 70% range pretty quickly and then continued up into the low 90% range.  We worked on her for a little over 12 minutes before the ambulance arrived.

The paramedics responded quickly and professionally, and collectively we managed to load her onto a stretcher while maintaining CPR.  The handoff lasted a little over five minutes before she was on the stretcher with the paramedics performing CPR and headed to the ambulance for transfer to the hospital.  The ambulance rolled out at approximately 20 minutes from the time I started my watch. Her mom rode with her in the ambulance.

A family member had been called out of bed to stay with the other kiddos, but she hadn't yet arrived.  Once the ambulance left, the police who came as well asked me if they could do anything. After I described the arrangements that had been hastily put together, the told me that if I needed anything I could call them back and they made their departure.

As I waited on the arrival of the other family member, I was at a loss. I talked to our oldest daughter who'd been so brave over the preceding half hour or so setting up medical equipment, turning on lights, getting the phone, and probably a whole host of things that I don't recall. We were both frightened.

The other family member arrived at the house and after a hasty status update and handoff, I proceeded to the hospital. When I got to the pediatric ER, the emergency medicine team was still performing CPR.  I looked at my Timex and the clock was still running.  It had been over one hour and twenty minutes.

It became pretty clear that the doctor in charge of the resuscitation efforts was moving in the direction of calling off the efforts and declaring our daughter dead. My insides were a dark hole of nothingness.  My wife went to the head of our daughter and whispered something in her ear. I don't know what she said, but almost immediately after over an hour and a half of CPR her heartbeat returned. Dark emptiness was replaced with hope. Once established again, her heartbeat recovered nicely even though she still required respiratory support.  

When she'd arrived at the first hospital, a call had been made to another hospital in a city about 45 minutes away by car that specialized in treating pediatric emergencies. Because of the weather that night, the helicopter that would have normally been used to transport a patient in our daughter's condition could not fly, so another ambulance was already on its way when her heartbeat returned.  She and her mother rode the ambulance north, and I went home to get both of us some clothes and toiletries for an indeterminate vigil.

When she arrived at the second hospital a number of diagnostic tests were run, and we spent most of the rest of that Sunday waiting for results, watching the machines track her heartbeat and help her with her breathing. By the evening of the fifth of January the preliminary results were in, and although the doctors were reluctant to be definitive this early in the fight for her life it was clear to me that they were not particularly hopeful for a positive outcome. A CAT scan of her brain revealed significant swelling consistent with anoxic brain injury. At the time, all hope was not gone and the extent of the damage would be revealed over the next 12 to 24 hours. The night of 05 January 2014 was simultaneously the longest night of my life. I did not want it to end because I was afraid of what the morning might reveal, and I did not want it to go on any longer because of the crushing uncertainty.  Minutes dragged on for an eternity and the hours flew by with an alarming rapidity.

That day had been a very long day.

I learned some valuable lessons that day. It was not the kind of abstract learning that you might get from books or study. It was the kind of tangible learning that comes from experience. I remember back to my classes on CPR, and I distinctly remember wondering if I'd actually be able to perform the required actions on a living person. CPR is a violent set of actions that during the practices in class felt intensely unnatural to me.  Two years ago today when faced with a situation that demanded that those doubts be put aside, I learned that I could do those things required. It did not feel natural or unnatural...it just was something that had to be done. 

I learned that CPR works. I'd heard the stories and read the statistics. I left all of those abstract experiences with a slight feeling of skepticism. When I saw that the pulse oximeter registered a pulse in her toe and that her blood oxygen content recovered to greater than 90%, I became a true believer in the stories I'd been told.  It was as if a switch had been flipped, and seeing the quick turn of events...from a complete and total flatline to objective evidence of replacing the efforts of our daughter's heart and lungs with our own efforts...gave me hope and the feedback that I needed to press on.  I'm grateful that we had that equipment.  When faced with a situation like this, almost no one else will. If you're doing what you've been taught, have faith that it's working and working quickly. I saw it with my own eyes.

I learned the value of not giving up, and the value of telling the universe what you want it to do for you. Although I still don't know what my wife told my daughter, her subsequent recovery of a pulse is evidence enough for me that something much bigger than the physical efforts being exerted in that room reached down out of the ether and turned the tide of the events in that moment. Her speech to our daughter was an act of pure faith, and the universe will often respond to that kind of raw spirituality. None of that would have been possible without a great number of people to continue to act in the face of very grave odds against success, and I'm grateful to them for their tenacity and refusal to give up.

Today was a good day, and with any manner of good luck, I'll be back again tomorrow to share how the events from two years ago continued to develop.  Unfortunately, you know what's coming at the end of this chapter, but like life itself the value is not as much in the destination as it is in the journey.  Thanks for walking this one with me.

Contemplating Mortality and the Role of Prayer

Today, the sun rose on the Anacostia River just as it has from the beginnings of the sun and the river occupying the same general area of space and time.

Sunrise on the Anacostia

Like every other sunrise before it, observed from this spot in space and time, this one was a unique gift that I had the privilege of witnessing.  If I am granted the gift of living to be one hundred and twenty years old, I will have been gifted the opportunity to witness an sunrise that is similar to this one, but totally unique 43.380 times.  That is really not that many sunrises, and I've expended over a quarter of them already.

I'm thinking about mortality because today I worked my way through most of the TED Talks that have been categorized as being related to death, and I received a request for prayer for a friend of mine's father who will be facing multiple bypass surgery tomorrow.

As for my choice to listen to educated people speak on the topic of death, I really have no real explanation other than I'm beginning at the front of the alphabetical index of TED Talks and listening to all of the talks that have an audio only recording in a given area that strikes my curiosity.  I've worked my way up to the letter 'D' so far and this is the next topic to draw my attention. The talks, like all TED Talks I've listened to so far are mostly interesting and always thought provoking. The general theme is one of finding a better way of accepting the normal process of mortality and a number of arguments about why and how this can be approached.

The prayer request, given the potential seriousness of the procedure that my friend's father is facing tomorrow seemed to mesh with the overall theme.  Honestly, I don't know how to respond to these calls for supernatural intervention when they come across social media like Facebook. I can't bring myself to push the "like" radio button, but I do feel compelled to reach out to my friend or acquaintance in response to their request that I entreat a higher power in support of their request for help. It's at this point, the point of wanting to respond, but not quite knowing what to say that I become a bit stuck.

Today, the request said, "Friend, my daddy will have multiple bypass a 6 tomorrow morning. Please pray for him and my mom!"  This request as of this writing has gotten 63 "likes" and 60 "comments."  One of the comments is mine, and I certainly didn't hit the "like" radio button, so I don't quite know what to make of those numbers. I ended up replying with "Done" although that leaves me a little cold and distant.

Part of my problem is that I have come to believe that prayer (and meditation) really represents an effort to grow closer to a higher power whose will is shaping the broad trends of our lives. I believe that the journey we are all called to in one fashion or the other is bringing our own will into alignment with the will of the greater power that surrounds us and having the strength and knowledge to glimpse and carry out the purpose that is laid before us by doing the next right thing moment by moment. I believe that seeking to understand the will of the greater power and having the strength and fortitude to play my small role in in the creation of that purpose is about the only thing that I should ask of that power. Anything more is probably an attempt to manifest my own will on a situation that far exceeds my ability to shape. This belief that prayer for knowledge and strength only is in conflict with my own will to shelter my friend for the pain of possible unwanted outcomes.  That's why I don't know how to respond. I don't know how to say that surrender is the only way I've found effective a coping with the fear and anxiety that this sort of situation can generate.

My friend, their daddy, and their mom are in my thoughts tonight. I want very fervently for things to work out successfully tomorrow in that operating room, and Mr. C to be granted some more sunrises to witness. I hope that I'm granted a sunrise or two in order to bear witness to the outcome. I hope that whatever may come finds my friend surrounded by love because that will make whatever comes better.