The time has come the walrus said…

 

 

Since mankind first began to form logical thought, we, as a race, have speculated about the nature of dying and death. Uncountable numbers of people have related their experiences with near death. What follows are mine.

 

Allow me to begin by removing some of the mystery surrounding bone marrow transplants as the transplant both saved me from imminent death and provided the framework for what I am about to relate.

 

The process begins by determining if the patient will actually survive the procedure. In my case this involved a couple of weeks of almost daily trips to what became nearly every hospital in the lower mainland and during which every major organ was evaluated. Once the transplant team felt there was a chance they would not be the primary instrument of my death, I was put on hormones which greatly increased the production of T-cells by my own bone marrow. A few weeks later these cells were filtered out in a process which involved a tube in each arm – one removing blood which passed through a refrigerator sized machine, the other putting the filtered blood back in. The result, after five or six hours was a bag of pink, creamy looking fluid which contained enough cells for two transplants. When a bed finally came free in the VGH transplant ward and I was admitted, we met with the lead doctor and he warned that my chance for survival was very low but without the procedure it was zero. I chose the transplant. Two days later in the mid-afternoon, I was administered an innocuous looking bag of clear liquid via my Hickman line (a multi-headed tube entering my upper chest and threaded into my heart). The following day, another bag, this one containing a cup or two of T-cells was dripped in the same way. Things gradually deteriorated after that. It was not sudden, as I had expected it to be.

 

My first real experience with personal death was a non-event, or rather a series of non-events beginning three days after the marrow killing chemo. It was thankfully hidden in the miasma of morphine and while I am quite certain I experienced something, it is lost in the mists. I now understand why that might be so, having had a couple more experiences later in the process of this illness which were very clear.

 

One of the side effects of chemo is a deeply depressed immune system. Infections of almost any kind can lead to fevers and a condition called rigors (pronounced rye-gores) – uncontrollable shivering. Rigors is a signal that things are quickly about to go very wrong and requires immediate application of fever reduction drugs and antibiotics to control the causative infection. The first few weeks in the transplant isolation ward were a constant series of rigors events followed by a crowd of caregivers administering intravenous antibiotics and morphine and doing whatever was required to control my vital organ functions and body temperature within a safe range. In my weakened and drugged condition I did not appreciate the frantic activity or the severity of the situation. In fact, I was finally put on constant IV antibiotics and given morphine on demand, supplied through a pump driven by a button pinned to my clothing. It was a very dreamy time. Food was supplied through the tube in my chest as were all drugs, blood products and fluids. At the time and given the high levels of morphine in my system and the generally poor condition of my health, I did not appreciate how many times I actually had to be rescued – and that was the term the staff used – it is not mine..

 

The chemo drugs were so toxic that my body wastes were considered to be a biohazard and while the hospital staff dressed appropriately to protect me, they were also very careful to protect themselves from the toxic effects of the drugs I had been given. Six weeks later, when I was finally able to begin eating and drinking normally (as opposed to through a tube) and fevers were not common events, I was punted from the ward and released to the care of family in Richmond. Following that I traveled to VGH three days a week for blood transfusions of various sorts and supportive medications. Three months after that I came home needing only weekly trips to my family doctor and the hospital in Campbell River.

 

I was warned to watch for fevers and given copious amounts of high grade codeine to control pain, digestive difficulties and fever spikes as well as sixteen or so other drugs to manage other things. I was also supplied with oral antibiotics which I was directed to take in the event of any infection which might lead to a fever. What I did not understand at the time is that oral antibiotics are a stopgap only until intravenous antibiotics can be administered – so the onset of rigors means an immediate trip to the hospital is required. To streamline this process, I was given a letter from the transplant unit at Vancouver General Hospital, printed on red paper, which allows me to bypass the emergency room process and as quickly as possible get into isolation and receive supportive care.

 

While this is all fine and good, one must realize that hospitalization is absolutely necessary and be prepared to go to the hospital at any time. It also assumes the patient will not be reluctant to go – as I was.

 

My first rigors event at home came late one night. I woke up to uncontrollable shaking and immediately took the maximum amount of codeine allowed and a double dose of oral antibiotics. I bundled up in a layer of blankets and sank into a drug-induced daze which thankfully led to sleep. What I did not appreciate at the time was that I very nearly did not survive the night. What I do remember before succumbing to sleep was a feeling of being completely disconnected from the world around me, becoming a small bubble of Mike in an empty universe. It was a very lonely feeling but not frightening. There was no tunnel with a bright light at the end – only a little bubble of me and infinity.

 

After later reporting the rigors event to my doctors, it was made very clear to me that the next one might be my last and I must get to the hospital as soon as possible in the event of another. Some time later that event came to pass. Again, I tried to control it at home but failed. What immediately followed was almost more memorable than the near-death experience itself.

 

The red letter did its job. I did not have to sit in the emergency waiting room. It was clear to the staff at the Campbell River Hospital that I needed to be in isolation so given no notice, the best they could do was put me in a supply room until a better space could be readied. While the thought was good, the supply room was in fact heavily used by emergency personnel and I spent the next five hours sitting in a chair – occasionally visited by doctors and nurses trying to stabilize my condition while the rest of the staff bustled through in search of supplies needed in their emergency facility.

 

My next stop was a private room all right, but because it was the best they could do on such short notice, was the TV room on the inpatient ward which had been hastily cleaned and had a bed wheeled into it. The nurses were masked and gowned however and I was given their undivided attention. Shortly thereafter and in spite of intravenous fluids, medications and blood products, the wheels fell off. My fever climbed out of control and my vital signs began to flag.

 

I remember stillness. It was not the quiet of the house at night but much, much more profound. As I unknowingly became more critically ill, my self-awareness actually sharpened but in a very strange way. The internal conversation we always have with ourselves started to fade away. The outside world became more like a paper cutout and I was a cutout within it. I could feel my body at an almost cellular level but the sicker I became, the slower the movement of the cells and the atoms which make up my body became. In an undefined amount of time (which had ceased to exist) everything stopped. I was whole but frozen in a singularity of silence, complete but trapped in timelessness within a frozen univese. In the normal world everything moves. We can even, in some small way, feel the hum and vibration of atoms. There was none of that. Nothing moved – not light, nor sound nor thought nor time. Had I been able to think or react I would have screamed just to shatter the absolute quiet and stillness. While I still had some sense of self, I was more connected to the universe than ever before, much like the cutout within the cutout – without internal conversation I became completely embedded in the reality in which I existed.The only way I can relate to it from a living viewpoint is to ask you to imagine your life as a movie and the film at the movie theatre breaks leaving the image on the screen frozen forever. You are in the shot and a part of it but not as a seperate individual. There is no way to remove or seperate yourself from the total image – you are just a part of it with no more ability to think or move than the image of yourself on the screen. It was that and so much more – or so much less.

 

It must have been shortly after some fairly aggressive medical intervention that I felt a few stray thoughts begin to move through my mind and they were that I was not ready to accept such a fate. I was not ready to be frozen in a single moment with no change ever possible again. While I was not really afraid, I was profoundly disturbed by the experience and totally unwilling to give up on the busy brilliance of human existence. Shortly thereafter in a strange time-warped way, that little bubble of Mike burbled out of the morass and rose like an air bubble from a diver’s breath to the surface of our shared universe.

 

I fully awakened in a third room, once a double ward room, then an office – now cleared and literally hosed down and disinfected with a single hospital bed in it and me in the bed – no furniture, no curtains and no exit. Given the very public spaces I had been in just previously, the isolation was almost funny. The staff were so very intent on maintaining that isolation. They entered only one at a time and only if completely masked and gowned and I was forbidden to leave. Meals were specially prepared, extraordinarily bland and sealed until opened in my room. Even toilet paper was missing – being replaced with sterile cloths which were removed as required. Thankfully, my recovery was swift and a few days later I was on my way home again.

 

It was only some weeks after that I was well enough again to realize what I had experienced. I am still trying to understand it today – almost two years later.

 

I am not yet ready to stop. There is too much joy in change and confusion. There is too much sweetness in the laughter of my children. There is too much sparkle in the sun on the leaves and too much pleasure in the aroma of a turkey in the oven. The very malleability of our living existence is like a drug I cannot give up.

 

One day I will give up – as will we all. I only hope it is a complete surprise because it looks to me like death means no more surprises.

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One Response to “The time has come the walrus said…”

  1. ceo Says:

    thank you for sharing. Just as I was about to get self indulgent and lothsome, my reading stops me. Keeps me from petty self pitty.

    thanks Brother

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