“Stay awake! Stay with us!”

On Friday I was about ready to leave for work when my nurse ran into my office for gloves and sprinted down the hall.  Running in our environment is never a good sign so I grabbed some gloves and ran after her asking why we were running.  A man was collapsed in front of the building.  

A few moments earlier he was sitting in my office while my nurse examined his wounds.  They were several days, maybe more than a week old.  He had a laceration to his scalp right along the hairline.  His right second knuckle was flayed open in a star shape.  He had several small wounds in both of his feet that looked red and inflamed.  His speech was disorganized.  It meandered from one topic to the next in a way showed his thinking was discontinuous.  He wasn’t my patient so I casually observed him from my desk while my nurse examined him.   There was a bowl of Christmas candy on the desk and he asked me if he could take some.  “Of course!” I replied.  “Take a couple.  Put them in your pocket for later.”

I found him crumpled up over a pice of curbing with his face resting partially on the curb and partially in the plants and dirt.  His eyes were closed.  His lips were blue.  I spoke loudly and jostled him to try to rouse him, “Hello? Are you okay?”  I felt for a carotid pulse briefly and didn’t find it.  “I think we’re going to have to start CPR.”  I looked up to make sure 911 was going.  The case manager that found him was already on the line.  My nurse and I moved him to his back.  I noticed breathing, “Thank, God.”  I felt for a pulse again and it was bounding.  My nurse cradled his head and we both loudly prompted him, “Stay awake! Stay with us!”  His unseeing eyes opened slightly and shifted laterally in his head.  He made a guttural sound and we gently rolled him onto his side in case vomit was coming.  

When the paramedics arrived he was lying on his side, head cradled in my nurses’ hands, appearing to be sleeping peacefully.  He was breathing steadily, pulse and blood pressure were fair.  They kindly got him onto the gurney and it was done.  

I learned that this man was released from prison in December and then immediately absconded.  He was referred to our program at his release but was lost to follow up.  His mother learned of his location and called the case manager Friday to let him know.  He was living in Balboa Park.  The case manager brought him into the clinic. 

I considered how it might have gone for this man if whatever caused this event had happened in the park.  He might have been fine, anoxic for a moment, then spontaneously rousing.  I can only imagine, but there might have been pain or a strange feeling, an aura.  Then face in the dirt, unconsciousness, cold.  Then waking up sore, either from the fall or the unnatural positioning of the body after the fall, or from the muscles cry for oxygen.  Light appears at the eyelids first parting and he realizes he is waking up in the nightmare, alone in a world where everything is dangerous.  At least he was able to come back to consciousness among people—people trying to help him.  Maybe that softened the nightmare.  Maybe he was oblivious to it. 

The day before, as I was meeting with the team, we discussed a patient who is dying of breast cancer.  I’ll call her Dejah.  Dejah was diagnosed last spring.  She has schizoaffective disorder, bipolar type, which is an underlying schizophrenia with an overlying mood disorder.  She knows her dad but has no real family connection.  She prefers to live on the streets.  I’ve seen her walking around town with her hair wrapped up in a cloth.  She is probably about my age.  Thin, black and beautiful.  When I meet with her she is kind.  She always wants to know how I am doing.  She wants to appear put together. 

This Fall I put the team on alert because she had started to lose weight.  Her BMI fell below 18, which means she was under healthy weight.  It seemed to be related to her cancer.  She could verbalize a plan for how to obtain food but it either wasn’t enough or she lacked the ability to follow through on it.  Her pattern has been to cycle through the hospital, return to housing placement for a day or a moment and then back to the street.  When she is in the hospital, she is pretty clear.  The combination of nutrition, medication, care and sleep bring her back to sanity.  On the street, drugs, cold, fear, and hunger undoes all of that.  

One of the case managers reported that Dejah had been hospitalized but left against medical advice.  We have been advocating for Dejah to be placed on conservatorship but because her psychotic symptoms clear while in the hospital, we haven’t been able to make that happen.  The hospital had planned to start her on palliative care.  “I’m worried she is going to die alone in the street,” my coworker said.  This is a real possibility.  

It caused me to reflect on my role in this life, on this earth.  There are moments when I can have an impact.  When I can actually help someone.  I am in a career where my role is to help people, but the opportunity to really help someone, in a meaningful way, is still evasive. 

For people like Dejah, my role, which is completely sacred, is to bear witness to her existence and her pain.  I knew her.  I will mourn her when she dies.  I will hold a space for her in my memory.  And my understanding of the nature of life will be deepened by knowing her, not as an other.  Not as the drug-spent, panhandler on the corner, but as the reflection in the mirror.  The part of me that can’t live with the pain.  

I am convinced that my ability to help others comes in touchpoints.  They are brief.  Opportunities for these come quietly and can leave unnoticed.  I find them when I open my eyes to the humanness of those around me and the humanness in myself.  They are not tied up in results.  Results are so cumbersome.  So much is out of my control.  All I really can control is how open I keep my eyes and my heart.  That someone might find the love of God in me and maybe I can find it in them.  Namaste.