Patient number a-15902 is lying in bed 10 and thinking about death. There is not much news in that, she has been thinking about death for the last 6 months, but for some reason, death doesn't seem to be thinking about her. sometimes it seems like it is finally coming, but then, like a bad dream, she is consciouss again, feeling everything and thinking about everything. I am dying to ask her what she is thinking about all this time. we are used to her being invisible. she is very quiet, as intubated patients tend to be, and usually they are also totally out. she isn't, however. she can hear everything. that is about the only sense she has left, along with the hopefully-worn-down-by-now sense of pain. today is a big day for her. we cut a hole in her throat and put the tube there, instead of going through her mouth. we really, really didn't want to do that. we even managed to extubate her a couple of times. but she just couldn't breath properly, and had to get on the tube again. and now there's a hole in her throat.
"water", she moves her lips quietly, unable to make a sounds, and i really, truly feel that I want to die. "just a minute mrs. K", and I soak a gauze-on-a-stick with water and let her suck on it like a popsicle. that is only one of the bonuses of removing the tube from your mouth and placing it right through your throat - you can start tasting things again. she is nearly ripping the gauze off in thirst. She definitely wants more. I am looking at her tatooed patient number, a-15902, and wondering if she ever experienced thirst like this over there. I want to ask her about that as well, but she wouldn't be able to answer. I would give her a pen and paper to write on, but she is totally blind. well, at least in europe she had her vision. at least that.
she gulps half a glass of water using the gauze-on-a-stick technique, and I am getting a little worried. I don't want her to aspirate anything in her lungs. for the last 6 months she has been poked twice daily, at least, using ugly needles, and sometimes tired physicians. she then had half her bowel removed due to an infection (caused by antibiotics we gave her, by the way). she then went on and off the tube a couple of times, each time getting it back, each time emergently, without being too cautious about lacerating her lip, or breaking her tooth. then, just as a cherry on top, she got a hole in her throat. It would have been great if her husband could at least come and support her, as he had for the last 30 years, being her cane and her eyes, but he is dead now. he died in the same car accident that kept her alive, conciouss, aware and remembering. She never had children, and the only family member sniffing around keeps asking us if we think she is going to survive because he needs to take of her finances. Why don't he gauze-on-a-stick a little, instead?
I am thinking about Job right now, and his dedication to god, and the torments he went through, and I have a feeling he would long be pagan if he had to go through what patient a-15902 went through. they say women are tougher than men, but this is just too much. If Satan was a doctor (not a very far fetched theory), this is probably what hell would be like.
We do try to treat her pain, really, realizing it's here to stay for a while, but then we might not be giving her enough, and it's not like she is saying anything, or protesting against the damn needle down her artery. on some days she is too feeble to resist, and in others, you have to hold her hand so it wouldn't withdraw once you poke her. I am actually doing it right now, and her tatooed number is looking right at me. I am going for her artery, right between the '1' and the '5', and I am wondering what was it like when they tatooed that number on her. did she resist? was she too feeble? she had her eyes back then, does she remember the tatooer? does she remember me?
She takes advantage of the nurse not noticing her for a minute, and tries to make a run for it by pulling the tube from her throat. the machine starts beeping. "stop it!" shouts the nurse, a very patient one on most days. I think he was concerned about her hurting herself more than anything else. he ties her hands and puts everything back into place. I go up there and her eyes are red and tearing. The lady means business. she does, indeed, want to die. the sooner the better, and everyone seems to have the same sentiment. why is she still with us then? we had younger patients, healthier patients, anything patients, who passed away. So why her?
I think about Mrs. K every day after work, and before I go to sleep. It seems like the ICU keeps reaching new peaks of human suffering, or maybe it's just the same peak all over again, what do I know.
I only know that I am not sure what force of life keeps Mrs. K going. I don't know if this is a story about the human spirit or just human misery, about indifferent doctors or about the futility of medical treatment. in fact, there may be no lessons to be learned from this, but just to tell its tale, and let you know, that there are people out there like Mrs. K.

Home

i am driving through heavy traffic on my way to work. the woman next to me slows down further, brings down her window and shouts across the road: "sarah!"
a woman across the road slows down her car, opens a window and says "Hi! how are you?"
"Good, and you? Have you heard about Esther?", she puts on a sad face.
"Yes, I went to the funeral", the other woman has a sad look as well.
"Ok, see you later!", they both smile and drive away.

To me, this little encounter is incredibly Israeli. First, they slow down traffic for a quick hello. second, within a second they go on to talk about death, and then it's all good again, and then they drive off.

that's how, on my first day in Israel, I knew I am home again.