excerpt from the book-length poem

*AWAKE, ALERT, ORIENTED

a poetry documentary of

Rhode IslandHospital

(RIH)

MedicalIntensive Care Unit

(MICU)

Get to a punch line.  Try to understand what’s relevant.  It doesn’t matter if she’s unemployed,it matters what’s the shape of the bacteria.  The shape of the bacteria might tell us the source ofinfection. 

Figure out what you don’tknow and try to get to know about that. Figure out what you can do without knowing the stuff you don’t know aboutwithout making things worse.  It’sOK to write things down, OK? Keep your notes with you, OK?                                       OK.

MICU rounds, AM

15June 2009

PATIENT #3—

“Ms. Kendra Ness, 32years old . . .

“twoweeks in the MICU as of 15 June 2009—”

“Who’s the nurse?”

                             “Abby.”

                                                            “—CallAbby.”

“—heart rate camedown to low one-hundreds from one-thirty,

                             “young,stable—

                                                            “she’syoung, but she’s stable—

“pain gone, has nausea,vomiting.  She lives at home, withher mom and her three kids—”

“Are the three kids hers?

“Maybe they’re her mom’s?”

“Non-smoker, non-IV-drug user, confessedoccasional alcohol use, doesn’t have a primary care physician, not taking any meds—”

                                                                    “Soundslike everything leads to vomiting.”

Sounds, like everything, lead to vomiting.

“Comfortableotherwise.  Her chest exam isclear, she’s making urine, she’s able to pee in a urinal—”

—pause—

“HA!”

“She’s able to pee in abedpan!”

—pause—

                                    “HA!HA!HA!— ”

“Hemoglobin 12, plateletsdown to 130—”

                                                                    “—It’susually: give cipro, obtain urine culture—”

“no hydronephrosis—”

“See! This happened the last time!

“Whatare you giving her for nausea?                                       Abby,what do you think?”

“Well, before—when he said her pain’sgone?—Well, she rated her pain 10 out of 10.”

“What do you rate herpain?” 

“It’s in her groin—”

“No, but what doyou—”

“it’s . . .          legitimate. ”

MICUrounds, PM

patientvisit—Ms. Kendra Ness

18June 2009

Kendra looks like apuddle.

“They look like puddlesbecause they are puddles.”

“Her skin has become thecontainer for her bodily fluids—instead of her vessels.”  Her belly is swollen and round.

Kendra’s face is swollenand round, her right cheek deflates on her pillow.  Eyes closed, eyelids crimson.  She’s not looking anywhere—eyes closed in to all thatfluid.

In the MICU,edemaoften occurs in patients who are being treated with large volumes of IV fluid.  The sodium in the fluid disrupts the usual pressuredynamics between the cardiovascular system and thesurrounding tissues. The sodium in the IV fluid moves out of the blood vesselsand into the space between blood vessels (called interstitial space).Water molecules then also move out of the blood vessels and into the interstitial space, so that theproportion of water to sodium inside the blood vessels comes to equal that proportionoutside the blood vessels.

Water may also move into the interstitial space if the plasmaproteins in the blood are reduced—for example, from malnutrition.  Usually, such compounds as plasma proteins pull fluid back into thecapillaries,providing counter-balance osmotic pressure across the capillary walls.  When these compounds are absent, watermay move into the interstitial space.

Aswater builds up in the interstitial space,the tissues become puffy, and people swell within their skins.  “They are puddles.” This is called edema. 

Get to a punch line.

Kendra died before her doctors discerned a sourceof infection.

Gauze covered her skin ulcers—purple andyellow bulls-eyes below her navel.

In the waiting room,Kendra’s friend arrives and hugs Kendra’s sister.  “You know, when she had the kidney transplant eleven yearsago, 32 seemed far away, like an advanced age. Now[1]—32?”

Tonight, morphine in Kendra’sblood, 32 seems as incomplete an age as any.  “It seems like 8 years old.”  It’s like 12 years old.  It’s like other ages when Kendra was living and was living—like3 hours and 3 months, 14 months, 3, 4, 9, 8 years

11, 15, 16 ½,

18, 22, 24, 27,

28, 29, 30, 31.

Before the morphine,pain—

Because of pain,morphine—

Pain,Age—

Time,Opiates—

Masses—clotted-blood-&-pusmasses, breaking—

       bursting through thin skin—

If“Kendra” is a Polish name, it means “long-haired woman.”  If “Kendra” is an Anglo-Saxon name, itmeans “understanding” or “knowledge.”   If “Kendra” is an English name, it combines the namesKen and Sandra, or Ken and Andrea. “Kendra” may be a variation of the name Kenda.  “Kenda” may be English for “water baby” (like Moses?), or itmay be Dakota for “magical power.” “Kendra” could be a female form of“Kendrick,” which may originate from the Welsh for “greatest champion”(Cynwrig) or the Anglo-Saxon for “family ruler” (Cyneric). “Kendra” may referto a beautiful woman, a goddess-like woman. “Kendra” may be a Curonian wordmeaning “cedar.”  The Latvian for“cedar” is “ciedra.” 

Curonianis a language with old and new forms, spoken in the Curonian Spit, by peoplewho also speak Latvian. The Curonian Spit is an elongated sand dune peninsula,98 km long and .4-4 km wide. It connects Lesnoj, in Russia, with Klaipeda, inLithuania, like a hair anchored in saliva would connect the ear to the mouthand frame the cheek. The Curonian Spit frames a lagoon, The Curonian Lagoon. TheCuronian Spit is a precarious formation. It has been threatened by winds and waves since prehistory.  Its survives, though, through ceaselesshuman efforts.[2]

Anurse cares for Kendra and one other patient.  An attending physician, five residents, one fellow and atransplant surgeon care for her, as well. Two sisters, one mother, three nephews, a childhood friend.  Some of the physicians examine herpersonally and some discuss, think, and consult regarding her case. I am here writingdown her story, and here you are reading it.

TheCuronian Spit survives the winds and waves because ceaseless human efforts combaterosion. For example, continuing stabilization and reforestation projectscombat erosion.

“Everythingleads to vomiting,” says one of Kendra’s doctors. “We don’t know the source ofinfection,” says another. Ceaseless human efforts swirl around her withouttouching the source, like a whirlpool with a center that is merely imaginary,just effort near a dark opening.

It took Kendra longer todie than her physician had predicted it would take her, by about threehours.  In the course of threehours, her mother and sisters encircled her, image of goslings reaching openmouths up to a mother bird, but inverted: the separate one below, her mouthslack and empty.

Kendra’s mother sang alullaby into her right ear. Kendra’s sister caressed her temple with the backof her right hand—tan and clean.

The third sister, flownup from Florida that afternoon, smiled and talked about her son.  She watched her mother and sisters andnarrowed her brow. “Kendra really loved Benjamin,” she said.  There, now I’m thinking about Kendra now.[3]