This excerpt from chapter two focuses on the narrative called the Intensive Care Unit.
Let’s suppose you ask your friend to meet you at (not in) a closet somewhere. In that closet is a mop and a bucket. Nothing else. You ask your friend to describe what he sees. He looks at you for the longest time and says,
“You brought me here to describe a mop and a bucket in a closet? Really?”
“Yeah!” you say.
“Are you okay?” he asks with a very puzzled and concerned look.
“Absolutely! Now, come with me to the hospital!”
“Are you having a breakdown?”
“Maybe, but just indulge me, okay?”
“Yeeaahhh . . . sure . . .”
You take him to the hospital’s Intensive Care Unit and ask him the same question.
“Uhhh . . . well . . . I see people. Is that what you want?”
“Great! Can you describe them?”
“Like their haircuts?”
“What are they doing there?”
“Oh, I got it now. Looks like some are doctors. Nurses, too. Then you got the people in the beds. They look sick. Like, really sick. Hooked up to a bunch of machines.”
“Is that it?”
“There’re some donuts on a table over there. Can I have one?”
“Do you see anything else?”
“Well, one has sprinkles on it. My favorite.”
Why am I writing what appears to be inconsequential dialogue? Okay, I’m a bored playwright who hasn’t had a play produced in a while. Putting that sad fact aside, your friend has done pretty well. Just as he accurately described what he saw in the closet—inanimate objects, he also accurately described the inanimate objects he saw in the ICU, especially the donuts. He could’ve gone on to describe other physical aspects of the floor he was on, such as the number of rooms and the nurses station.
Hey, wait a second, you say, he also described animate objects, the human beings. That’s right, he did. But he failed to describe the most important part of the ICU inhabited by human beings: its subtext, something he wouldn’t be able to do by merely walking into that part of the hospital.
Now you’re going to get all playwrightey hoytie toytie on me, you grumble. Well, yeah. Deal with it. So subtext is an implicit meaning in language that doesn’t match what is said or written. It’s what lies beneath the words we use. We use subtext all the time whether we know it or not. Let’s take a familiar example. Let’s say your partner tries on a new outfit. It gives you great pause. She/he asks you the dreaded question, “Well, how does it look?” You freeze for what seems to be an eternity as you fear for your life and then croak, “Uhh . . . you know . . . what’s most important is whether you like it, honey-goo-goo!” She/he then storms away vowing never to talk to you again because what you were really saying is that the outfit sucks and she/he looks terrible in it.
Yes, your friend did accurately describe what he saw on the surface. But, aside from the reactions we might have to what we see, from joy to horror, the visual appearance may be the least important and least interesting aspect of life. What lies beneath what we see is far more important and much more compelling, that is, the life narratives that inform who we are as human beings. And even more compelling are the webs of interactions among human beings that create and shape the narratives.
With that in mind, let’s explore the ICU. When you enter the ICU, whether as a patient—that’s assuming you’re conscious—or as a visitor, you can see and even feel a place where life and death commingle in strange and frightening ways.
Let’s dig deeper. Intensive. Care. Unit. It’s a world unto its own with a narrative that reflects those three words. Intensive: An extreme degree of concentration on a very sick patient by doctors, nurses, therapists, lab technicians, and others. Care: The use of any and all forms of medical intervention, from medication to surgery, to keep the patient alive. Unit: Yes, it’s what your friend described, but more importantly, it’s a “space” within which a narrative lives, the content of which is informed by the people in it and their roles. The doctors, who visit the patient maybe once a day during rounds, direct the medical intervention. The nurses execute the doctors’ orders, and, unlike the doctors, stick around with the patient and help him or her get through the day or night. The lab technicians, vampires in scrubs, stab the patient with needles to draw blood. Family and friends worry. The patient provides the puzzle, the problem that needs solving. Without this perilously sick person, the ICU narrative wouldn’t exist.
Is there hope in this world, this narrative, of the ICU, even if it’s limited to the micro variety I’ve described? For sure the medical staffers hope their interventions will keep the patient alive and improve the situation so that she can be transferred to a step-down unit and eventually be discharged. Friends and family will have the same hope, but perhaps dwelling more on the hope the patient won’t suffer—and annoying nurses with their demands in this regard. The patient? Assuming she’s conscious, she’ll likely be in a state of shock, a state of disbelief that shuts down hope altogether.
Everyone brings their own life narratives to the ICU, which can collide with each other at any given point. For example, a family member may be a lawyer who went to law school because his father died due to a doctor’s negligence—he distrusts doctors to his core. He may well clash with a doctor who’s earned a stellar reputation in her field and believes to her core in the power of medical intervention, focusing on the patient, not the family or friends. Enters stage left the social worker who, among other things, tries to keep the peace, tries to manage the clash of subtexts.
So here I come. The puzzle, the problem that needs solving. I suppose I should’ve felt l was the most important person in the world. After all, without people like me the ICU and its narrative wouldn’t exist. Hmmm . . .
The first thing I noticed when they wheeled me into the ICU was the cacophony of the machines and their alarms that were keeping people alive—from heart monitors to ventilators. As the days in the ICU turned into weeks and months, the cacophony became a sort of symphony of sounds with its own peculiar rhythm. I actually came to love those sounds. Had they stopped, I would’ve panicked. I’m not sure that can happen when you’re dead, though.
But I wasn’t dead yet. I was in the process of getting there. Why didn’t I wail or scream? Shock shuts you down, numbs you to prepare you for the transition to nothingness, the end of your life narrative.
Maybe I should’ve screamed at the top of my lungs. Because within hours of being admitted to the ICU the paralysis had crept up my waist and trunk and begun shutting down my lungs. My parents, Elaine and Pedro, were notified later in the afternoon as things got worse. They wanted to talk to me directly so they wheeled me to the nurse’s station and I told them in labored breath what was happening. They said they would drive up from Baton Rouge right away. It was if GBS gave me a time out to let me talk to my parents before it resumed its march up my lungs. It then took my throat, tongue, and mouth. Then even my eyes.
Within days, when it looked like my stay at hotel ICU would be for an extended period of time, they pulled the tube feeding me oxygen out of my throat and I was wheeled into the operating room where a surgeon cut a hole in the base of my neck—a tracheostomy—so that the ventilator could pump oxygen more directly into my collapsed lungs. Within days, the doctors had to cut a hole in my stomach to insert a feeding tube so that I wouldn’t starve to death. Within days, a heart surgeon went through my neck to put in a temporary pacemaker to keep my heart beating.
I was fighting for my life. “Booyah,” shouted Guillain-Barré Syndrome. I swear I saw it do a fist pump.