FIRST PERSON Standing By Death

SOME DAYS, IT SEEMS, I DO LITTLE else but watch people die. It is something I have been doing for a long time now, something no one wants to become good at, but does. You sign off the chart, gather up equipment, walk away.

On my thirtieth birthday, a fist closed inside my father’s chest and he fell to the floor. Almost without thought I started CPR, and the world came slowly back to his eyes. But it was a much smaller world than the one he’d left. For almost a year we watched him hunt empty fields, sniffing at the stillness, disability, pills. After numerous rehearsals, after an afternoon spent in a lawn chair in the sun, he at last left us.

Later there would be a woman 1 loved below me on the gurney following an attempted suicide. Waiting in ER, I would set out equipment-bag, mask, oxygen, intubation tools-and I would bend low over her, forcing her to breathe as we pumped her full of charcoal, fluids, and medication, looking into her still eyes for a clue.

For years, as I squeezed out my living as a writer, mine was a wholly portable life. I was a nomad, unpredictable folding up tent and disappearing over the horizon, lugging typewriter, files, guitar, and a few books (some I’d authored) from There to Here, resolutely living, as one friend put it, in the cracks of society. Then, with the collapse of the short-story market, the springs I’d been drinking from dried up, and I was forced, at age twenty-eight, for the first time in my life, to seek honest employment. What I found, and what has sustained me in all the many ensuing dry spells, is respiratory therapy.

I didn’t know much more about it then than you probably do now. Something about breathing, right? But they gave me a lab coat, a pressure-breathing machine, and about an hour’s instruction and turned me loose. I was to help keep some people from dying and help others reach up and pull down the air that eluded them.

An astonishingly long time passed before it occurred to me how very little I knew about what I was doing.

In his room late one night, Mr. Sheldon, dying of emphysema, showed me a tattered paycheck stub he’d carried in his wallet for more than thirty years, a souvenir of the week he’d made better than $1,000 operating heavy equipment. I thought for a long time afterward-in a sense, I’ve never stopped-of how we’re all diminished by increments, how the gray, whether we look away or stare into it, is always encroaching.

I came to know sad, gentle Debbie, eighteen, afflicted with cystic fibrosis, whose measured ambition became to graduate from “a regular school” and who did, and then, a few months later, died. On a day off, I came in to visit and found wastebaskets and floor filled with IV bags, suction canisters, drug ampules-all the detritus of our desperate attempts to say no to death-and her room empty.

I stood above newborns weighing just over a pound, forcing air into their lungs, watching as their heart rates dipped ever lower and their skin turned gray like ash or smoke. And over other children-chronic hearts, surgeries gone sour, Siamese twins-each with his own private battle pitched and going on invisibly above the bed. Again and again I marveled at their strength, at their blind will to somehow go on.

Eventually I did what I’ve always done when overwhelmed: I turned to books. For almost a year I read little but medical texts and journals. I passed the examination that would legitimize me as a respiratory therapist. I learned what I was doing, what could be done.

And now, for almost eighteen years off and on, whenever times have grown lean in Literature Land, I’ve done it.

A friend says of his army pension that it ruined his life: had it been just a little more he’d have been able to live as a human being, and had it been just a little less he’d have been forced into obtaining proper work. Sometimes I feel that way about my career as a therapist. I’ve never lacked employment, when I’ve wanted it. But it’s been almost too easy, and such ready, uncommitted work has kept me from making efforts to return to editing or teaching.

The ease of getting work, and the fact that the work is mobile, so unlike sitting behind a writer’s desk, have brought me back to RT again and again. Also, the work can change radically from day to day (or minute to minute) and offers welcome respite from the solitude and self-absorption of writing, taking me out among people of every sort. There is reassurance in a feeling that I encounter often as a therapist, a feeling of common humanity.

1 do sometimes wonder how all this- standing so often, and so closely, by death-has changed me.

But now it is another morning. Air goes inand out of my lungs. I know a little moreabout what 1 am doing now when 1 come tothese people we call patients. Some I havehelped, a few immeasurably. With manyothers, I could only stand on shore biddingkind voyage as they sailed out. But I havebeen there, at least. And they have not sailedout alone.