The stuff that life is made of...

I did not know this man, but his life and passing will affect my life and it will affect yours too. every person, regardless of how we know them, or don't, has a part to play in the order of things. It is unfortunate that he died and the way that his life ended. It is unfortunate that, quite often, we don't get to know the greatness, beauty and accomplishments of someone until they die. I often go to memorial services or funerals for people that I did not know very well, or at all, and I cry most of the time that I am there. Another beautiful soul that is gone, vanished from our existence/earth, and we will not get to tell them this. I regret that I did not get to know the person too well, either by default, or "I didn't have the time".
What makes this story more tragic, is that this man, Chris, lived with/took time to"deal with a broken heart." We are all broken people, but some of us are not given the chance or the choice to heal.

Spiritual Retreat

This past weekend was the CAPPE BC spring meeting. We had a retreat versus the traditional business meeting. The ambiance was calming and the day was called "Quiet Day for Nourishment" (and I forget the rest). We were led in guided meditations and given time for artistic expression. That being a mandala. Mandalas are designs that you color. The process is about the color. Sometimes it is an expression of the inner self expressing a theme. People expressed surprise at what came out. The symbolism and choice of colors. We were given opportunity for reflection and meditation as well. It was a good day, much needed.

Space in Between

In the end, it all comes down to what we think about this life here on earth. Isn't that it? We are all looking out the window to see what is coming into view. We are all waiting for ... something. Yesterday in Sunday's class, our group had a discussion related to our continuing series about the difficult questions in our Christian faith. The question we were to discuss was "how important is a belief in the afterlife?" Those of us present, about 12 of us, agreed that we believe in an afterlife-- that is there is a heaven and hell. We didn't really get around to discussing what we think heaven or hell is like, but instead spent our time discussing the impact that this belief has on this life here.
A point that I brought up is that we do not really discuss the "afterlife" or death until we have to (such as terminal illness, or deathbed) and at times, it can be too late as many unresolved issues surface and cannot be dealt with adequately. When these issues do surface, it is the perspective that we have about our death that puts our life in perspective. It is what we think about our death, where we will go, what happens when we die, that impacts the way we live our life. Hence we spend our time here in the Space in Between waiting until the end occurs. Waiting to be in the presence of God, wondering what it is like. But also wondering if it is how we imagine, wondering...
Looking out the window and waiting for something to come. for time to pass and the big event, or any event to occur.
But it is what we think lies at the end of the road that makes the waiting purposeful and with meaning. It is the end result that shapes how we live out the days of our life here in the space between.

You learn something new everyday... but did I want to learn this?

Yesterday I received a referal to see a patient on one of my units. He has a terminal illness and thought he should starting thinking about/make plans for his death. So I'm in his room, I've explained that the nurse called me after their conversation, and we have talked about his life and various issues for about 45 minutes, when he asked "so what are you for?" That was when I had to get blunt. "The nurse said that you were thinking about end of life issues and wanted to make some decisions like a will and such." He responded with "yes. I want my body shipped to [country overseas] when I die. My family over there can't really do it and there is no one here but me. So I figure I should do what I can now." So .. yesterday I learned about how you ship a body from Canada to an international country. I called up a local funeral home, told him that I had an odd request from a patient and wondered how to do this. It's a lot of paperwork really.

Say you die and you want to shipped to England, or Africa or wherever.. you need your birth certificate, the names of your parents, where you were born, where they were born, the name of the cemetery where you will be buried, the name of the funeral home in that country, your passport. You need to have permission from the consulate, (embassy), the town where you wish to be buried. But the main thing that will determine is the fee of the transport.. the airplane. Gas and other fees -- but the interesting thing is that it is cheaper to buy the casket (for burial) in the other country and to have a sealed shipping container for the body. The reason being that airlines charge by dimensions and weight.

Experience of God

This morning, I had to go back to work after the "holiday" and it has been steady. I am often called into interesting situations and some of them challenge my comfort zone, others are my "forte". Today I was paged to see a man who had requested our services. I had no idea why, the nurses did not specify.. so I went to his room and introduced myself. He wanted to go to the chapel but was not allowed to go alone due to his recent heart surgery. He needed someone with him in case something happened.

So we saunter down to the chapel and sit down. There is another person in the chapel praying, so I told him to sit anywhere. I went to the other side of the room for quiet meditation and prayer. After a while, we started to leave but instead sat down at the back of the chapel where he continued his story begun on our walk down to the chapel. He told me that he had started the 12 step program for NA and his journey to this point. I am always awed at the journey of some people. I felt very privileged to hear his story and told him so. He talked about being in contact with his Higher Power and how he came to this realization. And his experience of God, as I call Him. "It's better than any high that drugs can give you. I wish I had discovered this 40 years ago then I wouldn't have had to waste my life as I did."

He described vibrations and sensations attributed to the Higher Power. I told him that he is lucky to experience the presence of God in this way as many people take their relationship with God for granted. (I realize that it could be withdrawal, but the way he described it, I don't think that it was withdrawal. ) He explained that he has had such a warmth and peace spread through out him that he doesn't worry too much about the surgeries and "unknown" future.

I think is a great gift. Not everyone is able to "experience" God working in their lives. Some people experience it but do not know what it is, do not pay attention, and others long for it, seeking others methods to reach God. The irony is that as Mankind searches for God, God reaches out to us in ways that we can't often fathom.

Usually when someone says "the experience of God", the listener assumes conversion experience. This is the first realization of the power of God. Paul/Saul on the road to Damascus experienced God in a dramatic way. But this is not the way everyone meets God. Some people are brought to their knees, while others enter into God's presence through a logical route/thought process. Each experience of God is just as real as the next, because every individual is unique/different, hence the experience and relationship with God will be just as unique. It is when we tell people that their experience of God is false, that we turn people off. One woman I met told me that she had a near death experience, and gained much inner power from it, but was told by a doctor that her experience was a part of a delirium and hence negated.

When we preach AT them, versus talking WITH them. I have heard of so many people (whom I meet in my work, either staff, patients, families) who have a faith or belief in God, but have been so turned off of organized religion/worship. I have been told time and time again that it was a "well meaning person" (my opinion) who tried to guilt them into something, or chastised them for their problems that they had, that in the end, the person left the community of faith. How this affects their experience of God has always been a wonder to me.. I hope it does not paint God in a negative light.

Thought for the Day

This is written on our whiteboard in my office when I came in this morning...

You know you are carrying too many pagers when your pants fall down without undoing them!!

I know the feeling.. I have 6 pagers this morning.

Makes you wonder what life as a chaplain is about eh?

Quote

When I was at the latest CAPPE conference, I ran into one of my college buddies. She is the co-editor of the book, Spiritual caregiving in the hospital. Windows to chaplaincy ministry.
I have been reading it on and off since my return last month. The book is a compilation of essays from those practicing in the field of Spiritual Care. The authors are from Canada and the U.S. I am currently reading an essay about spiritual caregiving to terminally ill people. There is a quote from Robert McFarlane's book, Now That I Have Cancer...I Am Whole: Meditations for Cancer Patients and Those Who Love Them.

A scrawny, hairless man. Those formerly marvelous, marathoning muscles just hang on bones of unproductive and depleted marrow. The bright blue eyes are bloodshot. They peak out through tiny slits where my eyelids have glued themselves to each other. This skinny man is bent over, divided by an angry, red scar that looks like an N-gauge model railroad track .. My lips are red and puffy, like a sad circus clown. That’s the view through the eyes of reality.

Then there are the eyes of love. My wife sighs, “Every time I look at you, I fall in love all over again.” My daughters say, “Remember what good times we had when we were little girls and you lay down on the sofa after supper and we’d sit on the back of it and roll you off with our feet? You are the best dad ever.” My teammates call to say, “Hurry back. Nobody else has the reflexes to play third base as close to the batter as you do.” A now grown man tells me, “You have no idea how important you are to all of us on the campus in the sixties. You made us believe we could make a difference.” God says, “I love you just the way you are.” Those aren’t the eyes of reality; those are the eyes of love. They see me as I want to be and yet, for them, already am. Now that I have cancer, I can see myself through their eyes. I like seeing me through the eyes of love.” (p. 11-12)

Sometimes it is hard to see with the "eyes of love". Sometimes it is hard to be seen with the eyes of love and understand/appreciate what it really is. I think that it is especially important to remember that we are loved for who are, and who we can be... through love, because of love.

Can't Afford to Die

Lately there's an increasing number of people who tell us that they cannot afford the death of their loved one. So lately, there have been "mini services" at the hospital for the person and then they are taken to the funeral home for cremation, and/or burial. Then there are other issues related to death.

Once again this relates to a "morgue viewing". The family had arranged for a viewing of their loved one here at the hospital as many were from out of town. My colleagues were facilitating this process. This morning, the phone rang and my co-worker turns to me and laughs in disbelief.

"We have a viewing this morning, but no body."

"I'm sorry? What? No body?"

" Yeh, the funeral home picked it up last night."

"Oh man. and you have a viewing today?"
"Yes and a service."

"A service? In the viewing room."

"Well yes. They can't afford to use the funeral home, so they asked us to do a service here. Just the family I guess."

(In the end, the funeral home was called and the body was returned so that the family could have the viewing here.)

Normally, we advise people to wait for a viewing at the funeral home instead of the hospital, as the funeral services will do their hair, makeup, etc and the person will look less pale, etc. But this is getting to be an issue more frequently. Funerals cost a lot of money. I remember a tour of a funeral home in Nova Scotia, during the years of my seminary training. The room with caskets mounted on the wall was quite small. Big enough for a single file line to pass. The urns were pretty, but then I saw a price tag. $4895!! For the "vase", you're kidding me. The price, of course, referred to the services that go with the cremation. The cost for the chapel, for the personnel, the limo, the caterer, the newspaper notice and the list goes on and on. Extra expenses seem to come up. Maybe that is a part of why I told my mother when I was 13 or 14, that I wanted to be cremated. or put in a pine box. Too much expense for the "wood" of the casket, (or steel or whatever) and the satin lining, and tombstone, etc.

Of course this leads to a different issue as well. What people think about the dying process? What do we believe about life after death? what happens to us when we die? How do we relate to the person that once was, but now is a lifeless body? What do we think about the soul? In the end, the question about the relation of soul and body determine one's approach to a funeral I think. We want to honor the person, and need to say our goodbyes. The body being the way that we have related to the individual while they were living, is the final way that we relate to them even in their death. But we also know that this is a "shell", the container for the soul/spirit of the person that we knew. They are no longer with us physically and so we try to transition to a new/different way of relating to them, as we are no longer able to converse face-to-face.

Joke of the day

Well, it's not really a joke "joke". This morning in rounds, one of the staff told us about the priest who is a patient on one of our wards. He is awaiting a procedure and has been put on restricted intake. He was told he would have a "light" breakfast. When the staff member opened the tray, there was only 2 juice cups. The priest saw this and said.. well, I guess they really did mean "light". When I heard this, I replyed that had I been there I probably would have responded with "well, it is lent. Aren't you fasting?"

Most people thought this was funny. Fasting is not a practice that I could/would partake. The point of fasting is to abstain from too much. You would take in only what you need to survive. Lent is a time when we prepare our minds, soul, and body for the coming of Easter by denying ourselves certain items that give us pleasure. Often food, hence fasting. I read a book where the author describes her obsession with books. Lives, sleeps on books, literally. So she was challenged to give up reading books for Lent, and to this day, she claims that she continues this practice for every Lent.

Scenes from the office.. well, in my life maybe if not my office

Running out of sick days ??

"You're going to run out of sick days ,..lol" my sister wrote on MSN. Well, no, not really. Because here I am again. It's a Tuesday (my Monday) and this is the first day I had have to call in sick for the week. My husband and I both felt sick on Thursday near choir time, only I showed symptoms first. Sore throat and then sinuses clogged and you know the rest... I went to work on Saturday and spent the next 2 days in bed, my "weekend". And I convince "husband" to stay home. Not because I'm selfish or lonely, but he started to loose his voice as a result of his sore throat.

On Saturday, I came home wiped. I wasn't feeling so great, and I'm covering the whole building. The last thing I did before I left was counsel a family about the death of a 30 something year old male. His wife was just lost. Their whole families were showing up and she was just beside herself. I felt so bad for all of them, the mother, his wife... and the fact that I wasn't in Winnipeg for a family funeral didn't help either. They wanted to know what was next. So I had to tell them about funeral process and hospital policy,etc. Then I went home and hugged my husband (after scolding him for doing nothing all day because he too was sick, but I went to work, and he didn't even make supper ...) and told him I have no idea what life would be like without him. To lose someone when they are young... But to loose someone too soon. I don't know what is worse. So running out of sick days... no. Even if I did, I'd rather take care of myself so that I can take care of my husband as well as look after my patients and those I met in the course of my day.

Pictures from Niagara Falls

Poems from conference/workshops

When Someone Deeply Listens to You

When someone deeply listens to you

it is like holding out a dented can you have had since childhood

and watching it fill up with cold fresh water.

When it balances on the top of the rim

you’re understood.

When it overflows and touches your skin

you are loved.

When someone deeply listens to you

the room where you stay starts a new life

and the place where you wrote your first poem

begins to blows in your mind’s eye.

It’s as if gold has been discovered.

When someone deeply listens to you

your bare feet are on the earth

and the beloved land that seemed distant

is now at home within you.

-- John Fox

Essentially asks and answers the question, “what do we need from each other?” -- To be heard.

Love After Love

The time will come

when, with elation,

you will greet yourself arriving

at our own door, in your own mirror,

and each will smile at the other’s welcome,

and say, sit here. Eat.

You will love again

the stranger who was yourself.

Give wine. Give bread. Give back your heart

to itself, to the stranger who has loved you

all your life, whom you ignored

for another, who knows you by heart.

Take down the love letters from the bookshelf

the photographs, the desperate notes,

peel your own image from the mirror.

Sit. Feast on your life.

-- Derek Walcott

CAPPE Conference

February 8, 2007.

Wednesday

I have been in Niagara Falls for the past few days. I am attending the annual national conference for CAPPE. It has been very cold since we got here. Luckily we have a rental car for the week and a beautiful view of the Falls from our window. (Pictures to follow later) People tease us that since we are newly weds, we likely don’t care what view we have. This morning, I got up at 6:30 a.m. and left my husband in bed while I went off to the beginning of my day, starting with breakfast meetings. Oh joy oh bliss. Sure it was all you can eat, but come on!! 7 am... Are you nuts? By the end of the day we are tired and some are tired when they get up and can’t wait for the coffee to begin.

I have been a member of CAPPE for 10 years and have not been a single conference until this year. I figured I should since I am now the co-chair for the planning committee for the 2008 conference to be held in Victoria, BC in April. For some reason, CAPPE has had their conferences in February. But really who wants to fly in February? The blizzards, the air fare sucks, the traffic/delays. So we have proposed a theme centered on gardens as it will be Spring. I have met my last supervisor, the first mentor in chaplaincy, a college classmate from my second year of Bible College, another from my masters’ years, and a former co-worker since being here. It is so cool!! Talk about networking!!

This morning we heard a plenary speaker talk about “circles of trust” where one is asked open questions about a situation you describe. You are free to answer or remain silent. This was described further in the first workshop I had. Then in the afternoon, the workshop was about interfaith communications in pastoral care. I had thought it would be a bit more informative versus reflective. Tomorrow the plenary speaker and my first workshop of the day are BOTH in French, with translations available. As I have a tendency to read lips, I may not get much out of this one. Who knows?

But for now, I am tired and will watch TV with the hubby and try not to fall asleep during the shows.

February 11, 2007

Yesterday was a LOONNG day. I got up at 6 a.m. for a 7 a.m. breakfast meeting with the “steering committee” of this conference to assist us in our planning for next year’s conference. It was very helpful and informative. Some of their pitfalls won’t apply to our conference because we have hired a conference planning company called VenueWest who will take care of details like budget, registration, computers, etc. After this meeting, our day had a workshop and then the final keynote/plenary speaker who spoke about the importance of theological reflection for the focusing of our work. To assist with the “why” of our work. Do we love our job? Why do we do what we do? What is going on with specific case scenario?

After lunch, the conference had a worship session, final AGM and then ended with a banquet where we award certificates, etc. I skipped out during lunch for Sweetie and I to drive 2 hours to a town out side of Kitchener (which I pronounce “kitch’ner, for some reason… must be the Maritimer in me) where I met his mother’s sister and family. 6 kids!! I haven’t seen 6 kids in a family in a while. It was a good visit. I was tired though as the day had started early and I hadn’t taken my contact lenses out. We got back to the hotel at midnite and couldn’t find parking in the lot, so Sweetie parked on the side… in unofficial spot, and we went to bed.

Now after breakfast, we will drive 3 hours the other direction towards Belleville, where we will meet up with 2 of my college friends and hubby, who are from Ottawa. We figured Belleville is midway for both groups.

We’ll see how it goes.

Of course, there will be pictures for this.

Church vs State ??

Church vs. State? This was the article in the paper the other day about the "battle over the 4 remaing sextuptets". The parents are Jehovah's Witness who are refusing blood products for their children as per their religious belief. I don't think this is an article about Church and State, but rather it is an ethical question. We believe the right of people to choose, we believe in the right of people to believe something. But the problem comes when our belief or understanding is in conflict with what we understand as being right and wrong. Ethics is essentially about morals, and conduct -- doing what is right. There are so many factors though that get in the way of what is right or wrong. The question is.. are we doing harm to a person by doing a treatment or withholding?

Various people have opinions on the issue. The BC government has even stepped in to provide the refused medical treatment and the latest article in the paper says that the parents need to prove that the medical treatment/blood is not warranted for the survival of the children. Not sure what to think sometimes..

http://www.canadianchristianity.com/cgi-bin/na.cgi?nationalupdates/070118birth

Church vs State: Battle over surviving sextuplets (Vancouver Sun)

The province has forced at least two of the Lower Mainland's four surviving sextuplets to have blood transfusions as a life-saving measure, over the objections of their Jehovah's Witnesses parents.

"[B]ecause we choose alternative medical treatments to blood transfusions, we have been stripped of our parental rights and have been labelled unfit," he said.

However, at least two of three children taken into the province's custody on the weekend have received blood transfusions, a medical procedure opposed by Jehovah's Witnesses as it offends their religious beliefs.

At a hastily called press conference Wednesday, Children and Family Development Minister Tom Christensen would not comment specifically about the case, but said the ministry is obliged to ensure children receive appropriate medical care.
"Any time that we find that there's a child in need of protection for any reason, including the need for medical treatment, the ministry will look at the situation and determine whether there's action we need to take to ensure that the child is protected," he told reporters at the B.C. legislature.
Christensen said the ministry listens closely to advice from physicians and seizes children only as a last resort.

Excerpt from transcript.. words of parents:

We absolutely refused each and every time abortion was offered as an option. Life is precious and a gift from the Creator, Jehovah God. As Jehovah's Witnesses we believe that to have aborted any of our sextuplets would be a profound disregard for life and violation of God's law recorded in Biblical passages such as Exodus 21:22-23 and Psalms 127:3.
In the last two weeks of [my wife's] pregnancy, she was hospitalized at B.C.'s Women's and Children's Hospital.
The neonatologists, Dr. Albersheim and Dr. Lupton, asked us to decide whether we wanted our sextuplets resuscitated on birth. Without resuscitation the babies would die. They explained that one-half of babies born at 24 or 25 weeks gestation die before being discharged from the hospital. They also told us that of the babies that do survive, many will have severe life-long handicap.
The doctors told us they support parents' decisions not to resuscitate children born so premature. We told the doctors we wanted our sextuplets to be resuscitated.
Now, just three weeks later, because we choose alternative medical treatments to blood transfusions, we have been stripped of our parental rights and have been labelled unfit. Without any hearing, the Ministry of Child and Family Development acquired a treatment order over [baby 3] on Friday afternoon, January 26, 2007. The judge refused to give us any opportunity to testify, present expert evidence, or cross-examine the doctors. The judge did not even hear from the doctors or the social worker.
What makes this even more unfair is that our lawyer had written the Ministry the day before stating that if the Director intended to take any action concerning our children then we insisted on a fair hearing. ...
We want the best medical care for our children and want them to live.
We have consented to all required treatment and have asked the doctors to more actively employ available alternatives to blood transfusions. We will not, however, consent to blood transfusions.

BLOOD TRANSFUSIONS
Why some people refuse to have them:
- Jehovah's Witnesses refuse blood transfusions for religious reasons. According to the website www.watchtower.com, Jehovah's Witnesses view life as God's gift represented by blood. They believe the Bible's command that Christians must "abstain from blood." (Acts 15:28, 29).
- In 2001, 16-year-old Bethany Hughes of Calgary made headlines nationwide after refusing to undergo blood transfusions because of her strong Jehovah's Witnesses faith. Hughes died in September 2002, of leukemia after an unsuccessful court battle to refuse 38 transfusions.
- In 2003, 20-year-old Candice Unland of Morinville, Alta. tried unsuccessfully to challenge legislation that says a patient 18 years or older has the right to refuse a transfusion. Unland argued that a mature 16-year-old, such as Hughes, should also have the same right. The case was rejected by the Supreme Court of Canada.
- In 2005, a B.C. Supreme Court judge ruled against the right of a 14-year-old Jehovah's Witness from Vernon to refuse life-saving blood transfusions. The girl was suffering from a potentially fatal form of bone cancer. In her ruling, Justice Mary Boyd said the rights of a "mature minor" to make her own medical choices do not supercede the authority of the courts in British Columbia to protect her life and safety.

Extravagant "mis" direction

This is a weird news item, but not really classified as such. I thought it "unusual". I read the CBC news site from PEI, where I grew up, and today I saw this article about a woman who is donating her clothing to homeless in BC. Kind of odd if you think about it. True, there are more homeless people here and it is a documented fact. But it is still a bit unusual to send clothing from one end of the country to the other. Especially considering they are sending it via truck. The price of generosity. My thinking is that, sure these homeless people need help, but what about the ones that were in her region. They aren't exactly visible. Nor are most homeless persons. (not everyone lives on the street.. some crash on couches etc. But I'm sure there are better ways to "give" and less expensive.

"The Heart of the Matter"

This morning I found a copy of The Courier. This is a free paper that is found in the downtown area of Vancouver. I usually read The Georgia Straight as it has more availability, but I prefer the articles in the Courier. This edition of the Courier had an article about a patient that benefited from the Heart Program at St. Paul's. While it is not my program (I cover renal and geriatrics), I still found it to be a heartwarming story. The subheadline above the doctor's photo says "A day later the only surgeon in BC trained in life-saving technique would have been in England". I wasn't going to read this article but that grabbed my attention. The article is a bit long, but I was fascinated!

The heart of the matter
by Fiona Hughes-staff writer
At 22, Andrea Marrie is the picture of health. The athletic Campbell River native is five-foot-eight inches and an enviable 126 pounds. (She knows because she weighs herself every day, but not for body image-related reasons). Clear-skinned and with bright green eyes, Marrie has been hitting the slopes of Vancouver Island's Mt. Washington all winter where she coordinates ski lessons. She graduated with a biology degree last year at UBC and hopes to return to the university in the fall to start a master's program in occupational therapy.
To look at her, you wouldn't know about the life-threatening ordeal she experienced less than a year ago-except for half-inch wide scar that peeks out from the opening in her blouse. Stretching to below the rib cage, it's the kind of scar often associated with open heart surgery.
Her near-death experience began not long after she celebrated her 22nd birthday, when she, like many of her friends and fellow students, came down with what she thought was a simple bout of the flu.
Her bizarre story and even more startling recovery began last March. Marrie was working at one of her two part-time jobs while studying at UBC. It was a Friday night and she was at the East Side home of a wheelchair-bound man with a brain injury. Marrie was his homecare support worker for the evening. As the evening progressed, her hands and arms began tingling and she felt dizzy. She had been feeling unwell for a few days, but decided to go to work.
She could handle a cold, but what was happening to her then was more than run-of-the-mill aches and sniffles.
It frightened her enough that she called her boyfriend, Kenny Prichard, who was just coming out of a night class, to tell him she was beginning to feel very sick. As they were talking, her condition deteriorated and she decided she'd better call 911. After hanging up, her boyfriend and one of Marrie's roommates raced to meet her.
"I called 911 because it didn't feel normal," Marrie recalled. "I was kind of freaking out at this point."
As she was on the phone with a 911 operator, she broke into a cold sweat, fainted and dropped the phone, unable to tell the operator her location. Prichard and her roommate Kelsey Ragan arrived and found Marrie lying on the floor with the 911 operator still on the line.
"She was very pale and totally weak," Prichard recalls. "She could barely open her eyes. She was sweating but her palms were very, very cold. At this point, I realized this was more serious than we thought."
The ambulance arrived quickly and raced Marrie to Vancouver General Hospital, where she waited two hours to be seen. The ER staff diagnosed her with dehydration and the flu, but they kept her for observation overnight. Prichard left at 3 a.m.
Fairly certain it was a simple case of the flu, doctors released her the next morning with fluids to rehydrate. Prichard picked her up at 8 a.m. and took her home. It wasn't long before she started vomiting and feeling lightheaded.
Ragan insisted she go back to the ER, but this time at UBC Hospital nearer where they lived. Marrie felt too embarrassed to return to VGH.
"I didn't want to go back to the ER for just the flu," Marrie says. "I thought I'd tough it out. When we got there, I sat down and told Kelsey my roommate to go home and finish her term paper and that I'd be fine. I don't remember anything after that until waking up a week and a half later at St. Paul's Hospital."
After examining Marrie, UBC Hospital emergency staff raced her back to VGH. Prichard and Ragan, who sensed her roommate's illness was more than a flu and had not gone home to finish her term paper, followed by car. When they arrived at VGH and saw an unconscious Marrie hooked up to a breathing machine, multiple tubes and IV lines, and with half a dozen doctors hovering around her in the coronary care unit, Prichard's heart sank.
"I knew it was really bad then and I was freaking out at that point," he says. "I never thought she had something that could kill her. We asked the doctors how bad it was so one of them took us aside and sat down with us and told us it was very serious. They were brutally honest and bluntly told us, 'There is a possibility she could die tonight.'"
Marrie's parents had been called on Vancouver Island, but couldn't make it to Vancouver until the next morning. Prichard and Ragan were told to say their goodbyes.
That night, Dr. Anson Cheung was preparing for a trip to London, England the next day when his cellphone rang. It was VGH. He was told about a young woman who had gone into "cardiogenic shock" or heart failure, and to come to the hospital immediately.
Marrie's heart had failed so badly it could barely pump blood. Her body was going into shock and her other organs were shutting down. Marrie was dying.
Cheung, the surgical director of heart transplantation at St. Paul's Hospital, quickly hooked her up to an ECMO-a heart-lung machine that performs the functions her heart could no longer do-and transferred her to St. Paul's, the province's heart centre.
"The [ECMO] is quite bulky and it was a bit difficult to transfer her but we did it," says Cheung, who kept Marrie on the ECMO for another day.
Despite not knowing exactly what caused Marrie's heart to fail (the main theory, although even now no one is certain about the cause, is a virus due to the rapid onset of illness), Cheung and the transplant team at St. Paul's, including clinical nurse specialist Annemarie Kaan, concluded that she was a candidate for a heart transplant. But since no heart was available, Cheung inserted a mechanical heart pump, or ventricular assist device (VAD) into her abdomen. He is the only surgeon in the province trained to insert VADs. If Marrie had fallen ill one day later, she may not be alive today. Although Cheung would have flown straight back from England, he may not have arrived in time.
Cheung cracked open Marrie's rib cage to insert the one-and-half pound VAD into her abdomen and attach two tubes to the left side of her heart. The device was then connected to a battery-operated portable driver, or air compressor, which looks like a piece of carry-on luggage that can be wheeled around.
The VAD took over the pumping function of Marrie's heart. Ventricular assist devices are only used on critically ill patients who need a transplant and risk dying if a donor heart is not found soon. Patients with a VAD can return home and resume a more normal and relatively active life. By living at home rather than in hospital, patients increase their strength, which increases the chances of a successful transplant operation. Last year, 13 British Columbians received a VAD. Marrie was one of two patients requiring two of the devices. One in four patients who get a VAD, however, will die waiting for a transplant.
In most cases, a VAD is connected to the left and most important side of the heart, which pumps oxygen-rich blood to muscles, skin and organs. The right side of the heart receives the blood that has come back from body tissue and pumps it into the lungs, where it receives a fresh supply of oxygen.
The procedure, which Cheung had done numerous times at St. Paul's since introducing the VAD program at the hospital in 2001, took four hours. The surgery was a success, but Marrie wasn't in the clear. Her heart was getting worse.
A day after receiving her first VAD, Marrie was back in surgery to get a second fist-sized pump inserted into her right side.
"Usually, with bad heart failure if we fix up the left side of the heart the right side of the heart starts to get stronger as well," explains Kaan, an Australian nurse who was recruited to work at St. Paul's VAD program. "If not, we insert a second pump, which is very rare. It only happens in five per cent of [heart transplant] candidates. Andrea obviously needed a second VAD."
About a week after receiving the second pump, Marrie finally woke up. She remembers the moment with vivid clarity.
"I was delirious, confused and paranoid," the 22-year-old recalls. "I wasn't aware I was on the VAD when I woke or what had been done to me and I couldn't talk properly yet. But I could tell my mom was so happy and relieved to see me open my eyes."
Less than 36 hours after surgery, Cheung made Marrie stand and walk.
"I was scared trying to feel if my heart was beating. I was constantly putting my hand over my heart to see if I could feel it beating," she says.
Marrie then found out that she was on the wait list for a heart transplant if her heart couldn't recover on its own. Statistics weren't in her favour. No one in Canada and only a handful of patients around the world had ever survived without a transplant after receiving two VADs.
"It's a very rare occurrence for a patient to recover when two devices have been inserted," says Cheung, who trained at the University of Manitoba, Western, Stanford and was recruited to come back to Canada to work at St. Paul's. Cheung had previously been working and training in Pittsburgh, where he specialized in inserting VADs. In 2001, St. Paul's became the first hospital in Western Canada to insert VADs. There are now 10 centres across Canada inserting the devices, which have been extensively used in the U.S., Australia and Europe for two decades.
Canada was slow to introduce VADs because of a lack of trained surgeons and their prohibitive cost. Marrie's two titanium pumps cost $50,000 US each. The portable driver costs $75,000 US but can be reused for different patients. The pumps are a one-time use only device because blood flows through them, making them a biological hazard.
News of a transplant came as a shock to Marrie. Two weeks earlier, she'd been out on her regular five-kilometre run and had been snowboarding at Whistler and Mt. Seymour and playing intramural Ultimate at UBC. She was young and healthy. Heart transplant candidates are typically male, 50 or older and with a heart damaged from a heart attack.
With support from friends and family and a hospital psychologist, Marrie adjusted to the devastating news and her new life attached to a mechanical heart. She even developed a sense of humour about it all.
"My friends and I started calling the pumps Vaddie," she says smiling over peppermint tea at a Kits caf‚ recently.
Prichard admits that Marrie had her share of ups and down, but stayed positive and motivated.
"She was remarkably strong and tough during her recovery," says Prichard, who remains good friends with Marrie, from his home in Toronto. "Andrea has always been a motivated person in terms of school, work and friends and family. She had periods of frustration, but she mostly stayed positive and upbeat."
Five weeks after her two surgeries, Cheung discharged Marrie from St. Paul's. But she couldn't leave Vancouver just yet. She needed to stay close to the hospital for physiotherapy and regular monitoring of her heart and VADs. Her parents each took a leave of absence from their jobs and rented a basement suite in the city to be with their daughter. Marrie led as normal a life as possible, spending time with Prichard and her friends, going to the beach, which Cheung didn't like because of worries sand could get into the driver. Not all VADs require a portable driver. Some patients, larger men for example, are inserted with heavier pumps powered by a battery pack worn around the waist like a belt.
The average time on a VAD is six months, but one B.C. patient has stayed on a pump for 17 months. Cheung, who's earned the nickname "cardio cowboy" for his pioneering work in the area, said a patient can live for years on a VAD.
He also predicts that in five to 10 years, VADs will eliminate the need for heart transplants altogether.
"With the advance of these devices, their durability, their decrease in size and livability, [VADs] will become as common as pacemakers-we will be able to implant them permanently," says Cheung, who performs 90 per cent of heart transplants in B.C. "A person will be able to live on these pumps until they die at a normal age. With transplants, a heart only lasts 12 years on average and a patient has to be on anti-rejection drugs."
These devices, however, are not suitable for children.
"This is not a long-term solution for them. They are still growing, they're too small for the devices, they can't look after them properly."
Three and a half months after her ordeal started, Cheung and Kaan sat down with Marrie to inform her they wanted to remove the pumps. Marrie was happily surprised-and scared. The "Vaddie" twins had become a security blanket. Marrie knew her heart had gotten stronger, but she was still nervous about not having the pumps as backup.
Cheung and Kaan reassured Marrie her heart was robust and ready to work entirely on its own-and it did. Marrie's heart made Canadian medical history.
"Andrea is the only patient in Canada who had two VADs removed and had full recovery of her heart," Cheung says. "That only happens in about two per cent of cases worldwide."
Although still recovering, Marrie eventually moved back in with her roommates and her parents returned to their jobs on the Island. To keep busy, she took two courses at UBC and finally learned to cook. She's on two types of medication that she takes multiples times a day. Eventually, she'll be down to one medication, but she'll be on it for the rest of her life to ensure her heart beats in a slow steady rhythm.
"Andrea's heart rate was quite high when she was sick and if it [beats] too fast for too long, it can stress the heart," Kaan says.
Marrie is vigilant about her salt and fluid intake. She's allowed a maximum of 1.2 litres of liquid a day while in recovery. (Less fluid lightens the workload for the heart.) It's the reason she weighs herself every day at 9 a.m. Marrie weighed 135 pounds before falling ill and dropped to what she describes as an anorexic-looking 108 pounds while in hospital.
"If I gain three pounds a day it could be a sign of heart failure," Marrie explains, noting the weight gain would be fluid buildup. "I also check my blood pressure every other day."
Although she's been told she's completely in the clear, Marrie has had her share of panic. During her first night staying over at Mt. Washington, Marrie worried about her distance to the nearest hospital. Another time when she was snowboarding and hiking up a hill, she ran out of breath.
"'Hey, are you guys out of breath?' I asked the friends with me. They all said yes so I knew I was OK."
Marrie wants to travel and to visit Prichard in Thailand where he's just left for a UN internship to work with refugees. Maybe one day she'll have a family. But she wonders if all those things are possible.
Of course, says Cheung.
"Andrea's prognosis is excellent," he says. "She can train for a marathon if she wants and I would encourage her to travel. She can do whatever you or I do."
published on 01/26/2007

Close to the Bone

I have been home sick for most of the week. Now that I finally get my appetite and most of my strength back, I have to write/prepare for a funeral service tomorrow. It is my first Funeral service in Vancouver. I have done numerous memorial services as part of my work, but this is the first one where I am the sole officiant. I did a "joint" service at a local nursing home for one of my renal patients which received good comments from attendees. Some of my staff came as well.

It is harder to do a service for someone that you did not know very well.

Since I have been home, I have begun rereading some of my books that I normally don't have time for .. or the brain for. You have to be in a certain mood for some books. Especially when you do the type of work that I do. It's not that I deal with death and dying all the time, but the issue of illness and suffering does comprise a lot of my work. After a while, you want to read ANY thing BUT.. something related to your field of work. Yet it is ironic that when I look at my library, there is a spiritual and psychological component to even my novels.

Close to the Bone is one of the books that I picked up a few years ago. Probably because it was cheap and likely related to my work. It is talking about the way that suffering affects us, our response to suffering.. either our own, or someone else's. The author relates a Babylonian myth as part of the beginning pages in describing the experience that most patients experience as part of their hospital experience.

Inanna is a queen who descends the depths of the underworld, to see her sister who is suffering.

The descent of the soul into the underworld which illness can precipitate, does not always have the impact of a shocking, sudden and unexpected abduction or the immediate devastation of being at the center of a major earthquake. Persephone's myth applies when this is so, but there is a second myt that parallells the experience of people whole illness and decent occurs in stages through an incremental loss of footing in the ordinary world of good health: either they have an illness with a gradually worsening pattern, or they maintain the illusion of being in control and minimize the emotional impact of having a serious medical problem. The myth that resembles the journey they take goes back at least five thousand years to the Sumerian goddess of Inanna.
Inanna was the Queen of Heaven and Earth. Heeding the news that her sister goddess Ereshkigal, Queen of the Underworld, was suffering and in pain, she decided to pay her a visit. Inanna mistakenly assumed that she could descend with ease. She would find however, that the power and authority she had int he upperworld had no bearing on how she would be treated in the underworld.
Inanna knocked imperiously on the gate to the underworlds demanding that the doors be opened. The gatekeeper asked who she was, and then told her that in order to pass through, there was a price. She would find that there was not just one gate, but seven. At each one, the gatekeeper told her that she must take off something she was wearing to pass through. Each time, Inanna responded indignantly, shocked that this should be so, with the words: "What IS this?" Each time, she was told: "Quiet, Inanna, the ways of the underworld are perfect. They may not be questioned."
Her magnificent headdress, the crown that designated her authority, was removed at the first gate. The lapis necklace ... double strand of rich beads.. breastplate .. gold bracelets .. royal robe. Naked and bowed low, She entered the underworld. Over and over, at each gate, symbols of power and prestige, wealth, and office were taken from her. ... Over and over, she would say "what is this?" and be told, "Quiet Inanna. the rules of the underworld are perfect. They may not be questioned."
Whenever a person becomes a patient and enters a hospital, the experience is not unlike Inanna's. Metaphorically, there are a series of gates to go through, and at each one, something is taken away. At the door of the hospital, s/he unwittingly crosses the first gate. In increments, thereafter, a patient is stripped of dignity, choice and authority. However important the patient is in the world, however significant s/he is to someone else does not matter here.
The second gate is the admissions desk... the third gate is usually the hospital room. Here each patient takes off street clothes which are reflections of individuality and status and puts on standard hospital gown that often is ill-fitting, too short and opens up the back. ...
Metaphorically and actually, illness and hospitalizations strip us of what covered and protected us in many ways. Indignities happen, and a "what is this?" protest may be met by words and attitudes from hospital staff that resemble those that Inanna heard: "Quiet, Patient. The orders of the doctor are perfect. They may not be questioned." Even when our physician are healers whom we trust, and they as well as the others communicate what an why whatever is being done is required, and even if we are fully involved in the decision-making, the journey is still similar to Inanna's. There are still gates we go through, which strip up of persona and defense: we become exposed and bare-souled.
The writer goes on to say that when we have been stripped so much, we reach our bare core and find things that were buried, or that we were not aware of. We are faced with the raw product of Self. Suffering brings us in contact with things we would otherwise prefer to forget, according to Henri Nouwen, a theologian. It is what we do with this time of suffering or death that defines our character, and provides a model for others. Some aspects of suffering give us NO CHOICE, but we do have a choice as the author of this book continues in the chapter. We can face it with dignity, or we give up.

This experience of being stripped to the bareness of it all... this is what I see everyday. My staff see it sometimes more intensely than I do. When one sees and experiences suffering on a daily basis, there is something inside that cries out for someone to do something. The mind rationalizes that even though I cannot change the situation, I can often comfort in the care given. That or the brain reacts with one of many defense mechanisms so that the intensity and raw pain are not felt so deep by the caregiver, so that the vicariousness of it all isn't touching too deep. There is a necessity of balance. The caregiver needs to separate themselves from the suffering and pain they witness, but there needs to be some acknowledgement that this cannot go on.
Hard lessons in life.

I spoke too soon

I am feeling somewhat better. My husband on the other hand.. experienced the joys of my weekend, however, unlike him, I woke up whenever he did. Which was frequently.

I think that the symptoms are mainly gone and now it is a matter of recovering. This morning I got a call from the Occupational Health and Safety Nurse, telling me that they did declare on outbreak and closed a ward in my charge yesterday. And then proceeded to tell me about the latest news written in the paper about said topic. So I can't go to work til Thursday. Fine with me. Now I have to clean up the house and disinfect what I was too sick to do before.

This morning, I was called by the family member of the "funeral" I am to do on the weekend. The patient passed this am, and the staff were paging me not realizing I was not there for the day. But they did call my secretary's office and got things straightened out. Luckily, I had done some work for this yesterday in helping with arrangements as they wish me to do the service and also to have it at my church. We'll see what goes on. Considering it will be on my "day" to work, it might be an issue. We'll see about this too.

Being sick, especially on one's day off, is not fun. I was at work on Saturday doing the usual flow of the day. Spent a lot of time on one floor where a patient was dying. The family had asked that I do the service and assumed that it would not be long seeing the way the patient was failing. I told the family member that I would be back on Tuesday and she could contact me then about future arrangements. When I went home, I felt slightly nauseous, later with acute onset of nausea, vomiting and diarrhea. It lasted a little over a day. I have not had symptoms since returning from the doctor's. (Of course, one does not have symptoms... just like when you take the car to the mechanic...) But nonetheless, I have Norovirus Just as I suspected. I had been told by nursing staff that they had a few cases. This is fairly common occurrence in my workplace, happens 1-2 times a year. So as a result, I am not allowed to return to work until 72 hours after the last symptom. Which from what I can tell was earlier this morning. Of course, I haven't really eaten anything either.
So I was "resting" when I remembered that I had not yet called the church re: the memorial service. So I called to find out if I am allowed to have services for non-members, and the time, etc. Called the family member, gave more info, and my home number as I will not be at work tomorrow as previously stated... The patient is still with us.

You know, it is interesting. The dying process. There are certain generalizations and certain elements that are unique to each person. But inevitably, I will hear a question... why is this happening? What happens when it is all over (morgue and funeral protocol) when will this end? How long does this take? It is interesting really. It is different for every person. Some continue to fight/hang on.. while others declare themselves. One of my ladies decided to stop dialysis treatment, shocking many. The pain was too great for her, the quality of life not good, so she decided that enough was enough. I was visiting her on her last days. She asked me to deliver some items to some staff members "when I die tomorrow". Die tomorrow? don't talk like that.. No, she was firm. Tomorrow. And she was right. It is different with everyone. Every case has different issues, but in the end, the results are the same. Whether they were younger (50-60's) or at the end of the life span (80-90s). Life and death are interesting. And in the end, a soul is lost from us to join those who have gone on before.

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This morning, my husband and I went to the notary to begin the process of writing our will. We do not yet have children and there aren't too many assets to deal with, but it is better to write it sooner than later. One of the questions is whether a living will is be included. A will is a legal document, a living will is not, and hence a guideline for others to follow in the event that you cannot speak for yourself. My husband said if there is no brain function, than pull the plug, otherwise I want to live. For me, it is not that simple. I work in a hospital and see the various options. I understand the concept of quality of life (QL), and it means different things to different people. One man told me that QL for him was being to do his job... having his mind, another man's idea of QL was being able to go in the outdoors and go hunting.. his possible amputations would not be good QL. Irony is that despite this knowledge I haven't really defined what QL would be for me, nor have I written an advanced Health directive (aka living will), nor have I had a will. But then I'm young...