Savasana

I'm in my hot yoga class. 90 minutes. 105 degrees. Set your intention. I watch my face in the mirror, sweaty, flushed, focused. I picture his dusky face, swollen, putty-like, unmoving. Find your breath. His mother is sobbing in the front bench, a rumpled ball of tissue clenched in each fist. I hunch over awkwardly. She hugs me tight and trembly around my neck. She cries in quick Spanish into me. Find your balance. His dad, in his best suit, thanks me for coming. Use your core. His brother, his bone marrow donor, stands by the door, his spitting image. Find your breath. I cry. It's ok; no one notices. My tears fall into my sweat, and it all drips down to the floor. And in the end I'm laying in a puddle of my own salt. Savasana. Corpse pose. Remember your intention.

Tough Crowd

She has Down's Syndrome and Acute Myeloid Leukemia. This girl's personality fills a room. I walk in at the start of my shift. She's mad at me because I've told her she can't eat. "Leave me alone!" she pouts at me. "Get outta my face!" I try for a smile, "Can we be friends?" Silence. She rolls her eyes at me like a proper teenager. "Ok...guess I'll just be your nurse tonight." Tough crowd.

A Little Bit Louder Now

She just had her central line placed. I'm drawing her labs for the first time. She is SCREAMING at the top of her lungs, her face six inches from mine. "Does it hurt?" I ask. "No." "Are you scared?" I ask. "No." "So why are you screaming?" "I don't know," she manages before she starts screaming again. It's going to be a long night.

All My Bags Are Packed, I'm Ready to Go

These are the things I think while caring for him after he's gone: How he would throw his notebook from the bed to the floor and wait patiently for me to pick it up and hand it back to him before he threw it again. and again and again. Endearing tenacity. How he would beat his hand to his heart, his way of saying i love you. Sweet and poignant. How just hours ago a trio of nurses sang Feliz Navidad, loudly and poorly, because that's the only song we know in Spanish and we wanted to make him happy. How he shooed us out of the room, reaching instead for dad. And how now he is cold and unmoving. I look at him, blurry through tears that have collected but refused to fall. The dusky shade of my purple nail polish nearly lost in the dusky purple of his skin. I laugh. I have to. Because if I don't laugh, I have no idea what kind of noises will come pouring out of me. I laugh until the tears come and streak down my cheeks. I write his name on a tag and place it on his toe. I tie his hands together across his abdomen. I tie his feet together at his ankles. We take him to the morgue and return to his empty room. I watch as his mother puts his belongings into a giant bag, one by one. His father pushes his empty wheelchair slowly down the hall toward the exit. The wheels squeak as they turn, the chair strangely and newly weightless. They have taken their time and collected everything, now must leave behind the only thing that matters. This is hard. Walking home the sun was shining and it was nicer than it's been in a long time. I know that has nothing to do with anything, I just think it's a nice way to remember the end.

Good Morning

This kid is HIV positive. He is in a wheelchair. He has muscle problems and speech problems and vision problems. He was adopted by a foster mother who brought him back after a month because she couldn't do it. And every morning- EVERY morning- he wakes up with a smile. "I have a house and food and school and people that love me...my life is good," he says, and he means it, as he starts to sing along with the radio.

4am

It's 4am, we are literally in the middle of this guy's chemo. I'm checking orders, vital signs, and blood return on his central line. I'm changing fluids and medicating for nausea. The girl in the room next door is crying. My patient sighs. "Are you ok?" I ask, checking his monitor and his lines. "She sounds like she's in pain," he nods his head toward their shared wall. "I hope she's ok." He looks worried. He certainly has no shortage of things to worry about, yet he's worried about her. When you've lost a little faith in humanity, you can sometimes find it in the middle of the night, in the corner of the hospital.

Blink

"I wish you knew me before," she said to me one night, while she could still speak. I do too. I've seen pictures. She was stunning. She taught preschool. She just got married. She had headaches. She came to us, a brain tumor took over, and her regression began: her ability to walk, get out of bed, go to the bathroom left one at a time. In the end she lay in bed, eyes wide and scared, voice gone. Her mom never leaves her side. Her baby has become her baby once again. Her mom writes each letter of the alphabet on a plain piece of paper, clearly, in rows. She holds the paper in front of her daughter and points slowly to each letter, one at a time. My patient blinks when she wants her mom to stop and her mom records the letter. The letters blend together. We insert spaces where they're needed. It is in this manner she spells out what she needs, what she's thinking. HELPME. DONTLETMEDIE. ICANTDOTHISANYMORE. IWISHYOUDIDNTHAVETOSEEMETHISWAY. IMSORRY. It's tedious and time consuming and heart breaking. One letter at a time.

Soon

"Are you sad?" I ask. Her lip quivers, her head nods. "Why?" I ask. Her hands splay out, her shoulders shrug. She crawls into my lap. She nestles her head into my shoulder, and before i can do it she pats my back to comfort me. It's such an adult gesture made with such small hands. "Don't go," she says, her warm words pour into my neck. "I'll be back soon," I say as I gently pry her out of my lap. My 12 hour shift has sneaked nearer to 13. "When is soon?" she asks as I plop her down onto the floor. "Soon," I say again because I don't know the answer. The elevator doors close between us. My day is ending and hers has just begun.

A World Away

She came back down to our floor from the Intensive Care Unit a mess. Her toes are dead and black, circulation conserving itself to vital organs. The wounds on her legs and back are so deep you can nearly see through them; her immune system non-existent. Tubes in her nose, in her arms, in her chest. It's a lot to take in. As I'm processing it, I find a poster on her wall. A collage of pictures: prom, sleepovers, football games, life. Her hair is long, her smile innocent and genuine, her laugh captured at just the right moment. It wasn't that long ago, or that far away, but it's another world from where we are now.

Chocolate!

She is small. Her dark curly hair is matted to her head along a healing post op suture. She wakes early. She is pushed in her stroller around the big square of the unit over and over and over. Lap after lap after lap. She looks toward me when I wish her good morning, her eyes milky, blurry, unfocused and uncooperative. Her vision removed along with a tumor nestled on her brain stem. "Chocolate!" she screams in an aggressive, surprisingly commanding way. "Chocolate chocolate chocolate!!!" The girl knows what she wants.

Super Kid

His parents made up bright orange t-shirts with their son's name superimposed over the Superman logo. They hand them out to the nurses and doctors, and now the hallway is awash with orange. We have become a team- all of us. Team Super Kid. He's circling the unit, taking us in. His team. He is glowing. "Pretty thoon people are gonna be athking me for my autograph!" he lisps in delight. Pale arms and legs jut out of his too small Sponge Bob pjs as he marches down the hall. "Meet me in my room," he commands with a tiny pointed index finger, like he owns the place. And right now, he kind of does.

After Life

I’m in Egypt. It’s August. It’s hot. Hot. Hot. It’s the end of my trip and I’m tired. But I drag myself to the Luxor Museum. After the sticky, stinky, amazing mess of wonders at the Cairo Museum, I’m pleasantly surprised at the cool, quiet, organized collection. I walk through slowly, letting the artifacts and their stories suck me in as the fans on the walls whisper quietly.

It seems, for these ancient Egyptians, life itself meant next to nothing. The years spent struggling on earth- just a blip in the forever after, just a preparation for the after life. Tombs were elaborate storage units for the stuff that might be needed in the after life. And that stuff is what I’m looking at now. It’s boxes and bins, chairs, beds, sandals, jewelry, games. It’s mostly mundane, everyday life stuff (golden thrones aside). It’s nothing I would consider needing for an after life. The after-life they were readying for seems to be very much like life-life. It seems they planned to be organized, comfortable, bejeweled, and entertained long after their bodies quit being anything.

The museum is small. I’ve walked the perimeter, and have made my way to a small room in the middle. It is dark and empty, except for an open sarcophagus encased in glass. As I move closer to look at this wrapped up ancient person, this mummy, my mind flashes to the hospital. To the first girl I watched die. How I removed my hand from hers. How I held her mother. How I picked her sister up off the floor. How I bathed her body. How I tied her hands together at her wrists and her feet together at her ankles with fine white string, knots followed unnecessarily by bows. How I closed her mouth with a cloth chinstrap that was made specifically for this purpose—all to get her body just right before it hardens in some awkward, inhuman way. How I wrapped her in a white plastic drape, so the outline of her body was all that was left. And when I look at this wrapped body in Egypt, all I can think of is the body I wrapped in the Bronx. And how small the world is. And how little has changed. And how I hope there is an after life. And how I hope my girl is organized and comfortable and bejeweled and entertained.

Cheerio

This little one has been in the hospital almost 100 days. She's mid bone marrow transplant. Through a gown and mask and gloves I try to make her happy. She grunts and points until I understand that Cheerios is the answer. Cheerios I can do. Focused, tongue pressed out the corner of her mouth, she expertly uses her tiny thumb and pointer finger to select a single O. Success. She smiles. She eats exactly half and pulls down my mask to feed me the other soggy piece. I don't know if Cheerios have ever come so close to making me cry.

Pulling Teeth

This kid has been through it all, so I am shocked when he comes to me in tears. I scan him quickly, looking for any visible injury- swelling, bleeding- and find none. He opens his mouth and points to his front tooth as he rotates it with his tongue. His eyes widen. I tell him it's ok, the tooth will fall out. He shakes his head fervently and points to me. He wants me to do it. He's crying now, mouth still open. Oh boy. I check his platelet levels and his bleeding times and take a deep breath. I twist slowly with gloved fingers; his tooth, hanging on by a thread, gives up. We sigh in relief, he and I together. He smiles that classic toothless grin. "Do you think the tooth fairy will find me here? You know, cause I changed rooms today?" he asks, panic rising. And I am floored. He knows he can't have soda because of his kidneys. He know he can go home when his counts come up. He knows what it's like to sit alone in a bone marrow transplant room for weeks. He knows central lines and nephrostomy tubes. He knows what it's like to be so sick he can't eat for weeks. Or go to school. He knows fever, neutropenia, relapse. He knows all this and he believes in the tooth fairy. Which means tonight I get to be the tooth fairy. Because if he believes, then so do I.

Lost in Translation

In Spanish I can tell him I'm his nurse. I can ask if he has pain. I can ask if he needs medication. I can't tell him he's amazing and handsome and strong and I'm sorry and I would take it all away if I could. I can put my arm around his mom, but I can't communicate what I feel. Lo siento is not enough.

Rock On

I hear crying from her room. It carries around the corner, down the hall, and directly to me. I go to her, crawl into her bed, and scoop her into my lap. Her fever is breaking; she is hot and sticky. Blood pumps into her from a bag through a tube tunneled into her heart. Tears pour out from her squinted eyes, drip down her face, and puddle into my shirt, just above my heart. I rock back and forth, a metronome, and hum something quietly into her ear until her moaning subsides. And even then, I rock on.

Hair Today, Gone Tomorrow

This poor girl's head is a mess. Squares of thick braids hold on by a strand or two, surrounded by bald patches. She has been holding on to those braids like they're her last link to normal. I tell her the braids look like they're ready to go. She agrees to let me help. I find myself pulling out the remaining wisps of hair, which come out in clumps in my hand. I don't know what I'm doing. I am better at drawing blood cultures or giving chemo or infusing platelets than I am at doing this. But she doesn't need cultures or chemo or platelets right now. Right now she needs someone to transition her from balding to bald. So I do.

Diva

In the middle of the night I take the elevator up one floor to the intensive care unit, holding a little chemo cooler and a folder marked last name, first. Her room is sleeping, quiet and dark. Tubes breathe for her, taped heavily to the corner of her mouth. Tubes feed her, curved into her nose. I smile as I notice the two puffs of hair on her head that make her look just like Minnie Mouse. I adjust what needs adjusting, give her chemo, and retrace my steps back to the elevator, empty chemo cooler and a folder in hand. Several weeks later I was confused when I saw a bald child sauntering down the hall in a pink robe- DIVA scrawled in rhinestones across the back- enter my little Minnie's room. Then I realized she was my little Minne, just without her hair. Minnie without her ears, but with all her diva.

All About Me

She spends the evening with colored pencils and paper. When she finishes, she tapes it to her door. The paper is divided equally into four parts. In each corner, she has written about herself:

I am a girl.
I have parents.
I want to be a doctor.
I want to get better.

The simplicity of this makes me ache.

Balancing Act

He's 23 months old. His eyes squint and his nose wrinkles as he smirks up at me from underneath his mop of dark black hair. He's perfect. He has myofibroma - a benign tumor in his right arm. Two days ago he had his right arm amputated at the shoulder. The suture line where the arm used to be is impressive: purple and blue and healing. He sits crookedly in his crib, unable to get his balance quite right, as he searches with his left hand for an arm that isn't there. And his nose still wrinkles as he smirks up at me. And he is perfect. Still. And he will find his balance, I am sure.

Ins and Outs

This little girl is two. She’s the kind that melts your heart. She’s very, very sick. Her chemotherapy is causing sores from one end to the other. She has sores in her in her mouth, down her throat, and across her entire bottom. Open, excoriated, necrotic. Bleeding red and black. I have never seen anything like this. I’m easing her into a warm bath. She’s squirming and wincing, shaking her head and crying no, no, no. I hate myself right now, that I have to do this. Because I have nothing else to offer, I hand her a plastic cup to splash around with. She takes it and she smiles up at me. All teeth and dimples. And for a minute I can’t breathe. Because I don’t deserve that smile right now and she’s giving it to me anyway.